- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.82 / $15.66 / $20.10
| Facility | | $13.82 | $15.66 | $20.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.35 / $20.10 / $20.10
| Professional | | $13.35 | $20.10 | $20.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.23 / $35.92 / $42.09
| Professional | | $27.23 | $35.92 | $42.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.75 / $20.10 / $25.13
| Professional | | $16.75 | $20.10 | $25.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.04 / $20.10 / $32.52
| Professional | | $7.04 | $20.10 | $32.52 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.76 / $30.43 / $42.14
| Professional | | $18.76 | $30.43 | $42.14 |