- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.68 / $12.11 / $15.54
| Facility | | $10.68 | $12.11 | $15.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $15.54 / $15.54
| Professional | | $10.21 | $15.54 | $15.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.06 / $27.79 / $32.49
| Professional | | $21.06 | $27.79 | $32.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.95 / $15.54 / $19.43
| Professional | | $12.95 | $15.54 | $19.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.44 / $15.54 / $25.14
| Professional | | $5.44 | $15.54 | $25.14 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.50 / $23.52 / $32.56
| Professional | | $14.50 | $23.52 | $32.56 |