- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.23 / $12.73 / $16.32
| Facility | | $11.23 | $12.73 | $16.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.97 / $14.97 / $14.97
| Professional | | $14.97 | $14.97 | $14.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $16.32 / $16.32
| Professional | | $9.42 | $16.32 | $16.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.51 / $25.73 / $30.11
| Professional | | $19.51 | $25.73 | $30.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.61 / $16.32 / $20.42
| Professional | | $13.61 | $16.32 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.72 / $16.32 / $23.27
| Professional | | $5.72 | $16.32 | $23.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.24 / $21.79 / $30.62
| Professional | | $15.24 | $21.79 | $30.62 |