- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.39 / $14.04 / $18.02
| Facility | | $12.39 | $14.04 | $18.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.98 / $18.02 / $18.02
| Professional | | $11.98 | $18.02 | $18.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.98 / $25.05 / $29.32
| Professional | | $18.98 | $25.05 | $29.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.02 / $18.02 / $22.53
| Professional | | $15.02 | $18.02 | $22.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $18.02 / $22.69
| Professional | | $6.31 | $18.02 | $22.69 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.82 / $21.52 / $32.46
| Professional | | $16.82 | $21.52 | $32.46 |