- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.44 / $11.84 / $15.19
| Facility | | $10.44 | $11.84 | $15.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.83 / $15.19 / $15.19
| Professional | | $8.83 | $15.19 | $15.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.96 / $23.68 / $27.67
| Professional | | $17.96 | $23.68 | $27.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.66 / $15.19 / $18.98
| Professional | | $12.66 | $15.19 | $18.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.32 / $15.19 / $21.43
| Professional | | $5.32 | $15.19 | $21.43 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.18 / $20.03 / $28.49
| Professional | | $14.18 | $20.03 | $28.49 |