- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.62 / $14.31 / $18.36
| Facility | | $12.62 | $14.31 | $18.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.17 / $18.36 / $18.36
| Professional | | $12.17 | $18.36 | $18.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.88 / $32.82 / $38.45
| Professional | | $24.88 | $32.82 | $38.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.30 / $18.36 / $22.95
| Professional | | $15.30 | $18.36 | $22.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.43 / $18.36 / $29.71
| Professional | | $6.43 | $18.36 | $29.71 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.14 / $27.81 / $38.50
| Professional | | $17.14 | $27.81 | $38.50 |