- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.65 / $12.07 / $15.49
| Facility | | $10.65 | $12.07 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $15.49 / $15.49
| Professional | | $9.42 | $15.49 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.27 / $25.43 / $29.73
| Professional | | $19.27 | $25.43 | $29.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.91 / $15.49 / $19.37
| Professional | | $12.91 | $15.49 | $19.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.42 / $15.49 / $23.00
| Professional | | $5.42 | $15.49 | $23.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.46 / $21.52 / $29.79
| Professional | | $14.46 | $21.52 | $29.79 |