- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.49 / $18.62 / $22.39
| Facility | | $15.49 | $18.62 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $14.13 / $18.20
| Professional | | $10.00 | $14.13 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $22.39
| Professional | | $10.47 | $10.47 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $30.20 / $33.88
| Professional | | $23.44 | $30.20 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $22.39 / $28.18
| Professional | | $18.62 | $22.39 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $18.62 / $28.18
| Professional | | $7.76 | $18.62 | $28.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $25.12 / $41.69
| Professional | | $15.85 | $25.12 | $41.69 |