- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.92 / $15.89 / $65.62
| Facility | | $10.92 | $15.89 | $65.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.78 / $11.93 / $15.83
| Professional | | $11.78 | $11.93 | $15.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $10.40 / $10.40
| Professional | | $10.40 | $10.40 | $10.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.34 / $25.82 / $31.43
| Professional | | $20.34 | $25.82 | $31.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.24 / $15.89 / $19.86
| Professional | | $13.24 | $15.89 | $19.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.56 / $15.89 / $25.69
| Professional | | $5.56 | $15.89 | $25.69 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.24 / $25.42 / $35.09
| Professional | | $13.24 | $25.42 | $35.09 |