- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.88 / $11.20 / $14.38
| Facility | | $9.88 | $11.20 | $14.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $14.38 / $14.38
| Professional | | $9.42 | $14.38 | $14.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.43 / $23.39 / $28.46
| Professional | | $18.43 | $23.39 | $28.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.98 / $14.38 / $17.97
| Professional | | $11.98 | $14.38 | $17.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.03 / $14.38 / $23.27
| Professional | | $5.03 | $14.38 | $23.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.18 / $22.09 / $30.17
| Professional | | $10.18 | $22.09 | $30.17 |