- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.36 / $11.74 / $15.07
| Facility | | $10.36 | $11.74 | $15.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.01 / $15.07 / $15.07
| Professional | | $10.01 | $15.07 | $15.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.39 / $26.92 / $31.51
| Professional | | $20.39 | $26.92 | $31.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.56 / $15.07 / $18.84
| Professional | | $12.56 | $15.07 | $18.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.28 / $15.07 / $24.38
| Professional | | $5.28 | $15.07 | $24.38 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.07 / $22.82 / $31.59
| Professional | | $14.07 | $22.82 | $31.59 |