- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.81 / $13.39 / $17.18
| Facility | | $11.81 | $13.39 | $17.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $17.18 / $17.18
| Professional | | $11.39 | $17.18 | $17.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.27 / $30.70 / $35.94
| Professional | | $23.27 | $30.70 | $35.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.32 / $17.18 / $21.48
| Professional | | $14.32 | $17.18 | $21.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.01 / $17.18 / $27.80
| Professional | | $6.01 | $17.18 | $27.80 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.04 / $26.01 / $36.02
| Professional | | $16.04 | $26.01 | $36.02 |