- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.23 / $12.73 / $16.32
| Facility | | $11.23 | $12.73 | $16.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $16.32 / $16.32
| Professional | | $9.02 | $16.32 | $16.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.52 / $24.43 / $28.60
| Professional | | $18.52 | $24.43 | $28.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.61 / $16.32 / $20.42
| Professional | | $13.61 | $16.32 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.72 / $16.32 / $22.10
| Professional | | $5.72 | $16.32 | $22.10 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.24 / $20.68 / $29.43
| Professional | | $15.24 | $20.68 | $29.43 |