- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.67 / $13.22 / $16.97
| Facility | | $11.67 | $13.22 | $16.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.19 / $16.97 / $16.97
| Professional | | $11.19 | $16.97 | $16.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.00 / $30.33 / $35.54
| Professional | | $23.00 | $30.33 | $35.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.14 / $16.97 / $21.21
| Professional | | $14.14 | $16.97 | $21.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.94 / $16.97 / $27.46
| Professional | | $5.94 | $16.97 | $27.46 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.84 / $25.70 / $35.59
| Professional | | $15.84 | $25.70 | $35.59 |