- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.07 / $15.95 / $20.47
| Facility | | $14.07 | $15.95 | $20.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.23 / $20.47 / $20.47
| Professional | | $9.23 | $20.47 | $20.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.85 / $24.86 / $29.15
| Professional | | $18.85 | $24.86 | $29.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $20.47 / $25.59
| Professional | | $17.05 | $20.47 | $25.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.17 / $20.47 / $22.53
| Professional | | $7.17 | $20.47 | $22.53 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.01 / $21.71 / $29.97
| Professional | | $17.01 | $21.71 | $29.97 |