- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.12 / $14.87 / $19.07
| Facility | | $13.12 | $14.87 | $19.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.78 / $19.07 / $19.07
| Professional | | $11.78 | $19.07 | $19.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.26 / $32.01 / $37.44
| Professional | | $24.26 | $32.01 | $37.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.90 / $19.07 / $23.85
| Professional | | $15.90 | $19.07 | $23.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.68 / $19.07 / $28.94
| Professional | | $6.68 | $19.07 | $28.94 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.80 / $27.08 / $37.49
| Professional | | $17.80 | $27.08 | $37.49 |