- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.78 / $14.48 / $18.59
| Facility | | $12.78 | $14.48 | $18.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.37 / $18.59 / $18.59
| Professional | | $12.37 | $18.59 | $18.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.21 / $33.26 / $38.88
| Professional | | $25.21 | $33.26 | $38.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $18.59 / $23.24
| Professional | | $15.49 | $18.59 | $23.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.51 / $18.59 / $30.07
| Professional | | $6.51 | $18.59 | $30.07 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.35 / $28.13 / $38.95
| Professional | | $17.35 | $28.13 | $38.95 |