- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.56 / $11.97 / $15.36
| Facility | | $10.56 | $11.97 | $15.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $15.36 / $15.36
| Professional | | $10.21 | $15.36 | $15.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.83 / $27.47 / $32.17
| Professional | | $20.83 | $27.47 | $32.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.80 / $15.36 / $19.20
| Professional | | $12.80 | $15.36 | $19.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.38 / $15.36 / $24.85
| Professional | | $5.38 | $15.36 | $24.85 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.34 / $23.26 / $32.20
| Professional | | $14.34 | $23.26 | $32.20 |