- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.55 / $15.36 / $19.72
| Facility | | $13.55 | $15.36 | $19.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $19.72 / $19.72
| Professional | | $9.42 | $19.72 | $19.72 |
- 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
- $16.43 / $19.72 / $24.65
| Professional | | $16.43 | $19.72 | $24.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.90 / $19.72 / $24.65
| Professional | | $6.90 | $19.72 | $24.65 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.60 / $22.18 / $31.01
| Professional | | $17.60 | $22.18 | $31.01 |