- 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
- $10.60 / $16.03 / $16.03
| Professional | | $10.60 | $16.03 | $16.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.73 / $28.66 / $33.54
| Professional | | $21.73 | $28.66 | $33.54 |
- 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 / $25.94
| Professional | | $5.61 | $16.03 | $25.94 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.96 / $24.26 / $33.59
| Professional | | $14.96 | $24.26 | $33.59 |