- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.02 / $12.49 / $16.03
| Facility | | $11.02 | $12.49 | $16.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.87 / $16.03 / $16.03
| Professional | | $6.87 | $16.03 | $16.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.00 / $18.46 / $21.57
| Professional | | $14.00 | $18.46 | $21.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.36 / $16.03 / $20.04
| Professional | | $13.36 | $16.03 | $20.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.61 / $16.03 / $20.04
| Professional | | $5.61 | $16.03 | $20.04 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.63 / $16.12 / $23.38
| Professional | | $12.63 | $16.12 | $23.38 |