- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.59 / $13.14 / $16.86
| Facility | | $11.59 | $13.14 | $16.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.19 / $16.86 / $16.86
| Professional | | $11.19 | $16.86 | $16.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.85 / $30.15 / $35.26
| Professional | | $22.85 | $30.15 | $35.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.05 / $16.86 / $21.08
| Professional | | $14.05 | $16.86 | $21.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.90 / $16.86 / $27.26
| Professional | | $5.90 | $16.86 | $27.26 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.74 / $25.51 / $35.32
| Professional | | $15.74 | $25.51 | $35.32 |