- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.48 / $15.28 / $19.61
| Facility | | $13.48 | $15.28 | $19.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.46 / $19.61 / $19.61
| Professional | | $7.46 | $19.61 | $19.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.26 / $12.61 / $17.11
| Professional | | $10.26 | $12.61 | $17.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.34 / $19.61 / $24.51
| Professional | | $16.34 | $19.61 | $24.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.86 / $19.61 / $24.51
| Professional | | $6.86 | $19.61 | $24.51 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.37 / $11.44 / $24.02
| Professional | | $7.37 | $11.44 | $24.02 |