- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.66 / $12.08 / $15.50
| Facility | | $10.66 | $12.08 | $15.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $15.50 / $15.50
| Professional | | $10.21 | $15.50 | $15.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.02 / $27.72 / $32.43
| Professional | | $21.02 | $27.72 | $32.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.92 / $15.50 / $19.38
| Professional | | $12.92 | $15.50 | $19.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.43 / $15.50 / $25.07
| Professional | | $5.43 | $15.50 | $25.07 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.47 / $23.45 / $32.47
| Professional | | $14.47 | $23.45 | $32.47 |