- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.91 / $11.23 / $14.41
| Facility | | $9.91 | $11.23 | $14.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.61 / $14.41 / $14.41
| Professional | | $9.61 | $14.41 | $14.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.55 / $25.80 / $30.18
| Professional | | $19.55 | $25.80 | $30.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.01 / $14.41 / $18.02
| Professional | | $12.01 | $14.41 | $18.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.04 / $14.41 / $23.33
| Professional | | $5.04 | $14.41 | $23.33 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.45 / $22.14 / $30.24
| Professional | | $13.45 | $22.14 | $30.24 |