- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.90 / $13.49 / $17.32
| Facility | | $11.90 | $13.49 | $17.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $17.32 / $17.32
| Professional | | $9.42 | $17.32 | $17.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.51 / $25.73 / $30.11
| Professional | | $19.51 | $25.73 | $30.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.43 / $17.32 / $21.65
| Professional | | $14.43 | $17.32 | $21.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.06 / $17.32 / $23.27
| Professional | | $6.06 | $17.32 | $23.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.16 / $21.79 / $31.01
| Professional | | $16.16 | $21.79 | $31.01 |