- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.86 / $15.71 / $20.16
| Facility | | $13.86 | $15.71 | $20.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.35 / $20.16 / $20.16
| Professional | | $13.35 | $20.16 | $20.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.33 / $36.04 / $42.15
| Professional | | $27.33 | $36.04 | $42.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.80 / $20.16 / $25.20
| Professional | | $16.80 | $20.16 | $25.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.06 / $20.16 / $32.61
| Professional | | $7.06 | $20.16 | $32.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.82 / $30.51 / $42.25
| Professional | | $18.82 | $30.51 | $42.25 |