- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.79 / $13.36 / $17.14
| Facility | | $11.79 | $13.36 | $17.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $17.14 / $17.14
| Professional | | $11.39 | $17.14 | $17.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.23 / $30.65 / $35.85
| Professional | | $23.23 | $30.65 | $35.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.29 / $17.14 / $21.44
| Professional | | $14.29 | $17.14 | $21.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $17.14 / $27.73
| Professional | | $6.00 | $17.14 | $27.73 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.00 / $25.96 / $35.95
| Professional | | $16.00 | $25.96 | $35.95 |