- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.93 / $15.79 / $20.27
| Facility | | $13.93 | $15.79 | $20.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $20.27 / $20.27
| Professional | | $11.39 | $20.27 | $20.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.85 / $27.34 / $34.18
| Professional | | $24.85 | $27.34 | $34.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.89 / $20.27 / $25.34
| Professional | | $16.89 | $20.27 | $25.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.09 / $20.27 / $27.94
| Professional | | $7.09 | $20.27 | $27.94 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.36 / $22.80 / $38.00
| Professional | | $14.36 | $22.80 | $38.00 |