- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.62 / $12.03 / $15.44
| Facility | | $10.62 | $12.03 | $15.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $15.44 / $15.44
| Professional | | $10.21 | $15.44 | $15.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.93 / $27.59 / $32.29
| Professional | | $20.93 | $27.59 | $32.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.87 / $15.44 / $19.30
| Professional | | $12.87 | $15.44 | $19.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.41 / $15.44 / $24.97
| Professional | | $5.41 | $15.44 | $24.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.41 / $23.37 / $32.36
| Professional | | $14.41 | $23.37 | $32.36 |