- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.61 / $14.30 / $18.35
| Facility | | $12.61 | $14.30 | $18.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $11.10 / $50.00
| Professional | | $10.74 | $11.10 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $9.42 / $9.42
| Professional | | $9.42 | $9.42 | $9.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.43 / $23.39 / $28.46
| Professional | | $18.43 | $23.39 | $28.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.29 / $18.35 / $22.94
| Professional | | $15.29 | $18.35 | $22.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.42 / $18.35 / $23.27
| Professional | | $6.42 | $18.35 | $23.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.79 / $27.65 / $31.01
| Professional | | $21.79 | $27.65 | $31.01 |