- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.05 / $11.39 / $14.62
| Facility | | $10.05 | $11.39 | $14.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $14.62 / $14.62
| Professional | | $9.42 | $14.62 | $14.62 |
- 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
- $12.18 / $14.62 / $18.27
| Professional | | $12.18 | $14.62 | $18.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.12 / $14.62 / $23.27
| Professional | | $5.12 | $14.62 | $23.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.64 / $21.62 / $30.17
| Professional | | $13.64 | $21.62 | $30.17 |