- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.64 / $12.06 / $15.48
| Facility | | $10.64 | $12.06 | $15.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $15.48 / $15.48
| Professional | | $10.21 | $15.48 | $15.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.97 / $27.66 / $32.36
| Professional | | $20.97 | $27.66 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.90 / $15.48 / $19.35
| Professional | | $12.90 | $15.48 | $19.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.42 / $15.48 / $25.02
| Professional | | $5.42 | $15.48 | $25.02 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $23.41 / $32.42
| Professional | | $14.45 | $23.41 | $32.42 |