- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.31 / $15.08 / $19.36
| Facility | | $13.31 | $15.08 | $19.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.76 / $19.36 / $19.36
| Professional | | $12.76 | $19.36 | $19.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.20 / $34.56 / $40.47
| Professional | | $26.20 | $34.56 | $40.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.13 / $19.36 / $24.20
| Professional | | $16.13 | $19.36 | $24.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.77 / $19.36 / $31.29
| Professional | | $6.77 | $19.36 | $31.29 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.07 / $29.28 / $40.54
| Professional | | $18.07 | $29.28 | $40.54 |