- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $13.49 / $16.22
| Facility | | $11.22 | $13.49 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $12.02 / $16.22
| Professional | | $6.03 | $12.02 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.33 / $9.33 / $16.22
| Professional | | $9.33 | $9.33 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $26.92 / $29.51
| Professional | | $20.89 | $26.92 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $16.22 / $26.30
| Professional | | $13.49 | $16.22 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $16.60 / $23.44
| Professional | | $5.75 | $16.60 | $23.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $21.38 / $30.90
| Professional | | $15.14 | $21.38 | $30.90 |