- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.16 / $11.51 / $14.77
| Facility | | $10.16 | $11.51 | $14.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.54 / $13.94 / $74.31
| Professional | | $13.54 | $13.94 | $74.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.61 / $14.77 / $14.77
| Professional | | $9.61 | $14.77 | $14.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.85 / $30.00 / $31.66
| Professional | | $25.85 | $30.00 | $31.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.31 / $14.77 / $18.47
| Professional | | $12.31 | $14.77 | $18.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.39 / $14.77 / $23.38
| Professional | | $7.39 | $14.77 | $23.38 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $18.10 / $29.47
| Professional | | $10.46 | $18.10 | $29.47 |