- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $15.14 / $18.20
| Facility | | $12.59 | $15.14 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $10.96 / $14.13
| Professional | | $7.94 | $10.96 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.12 / $9.12 / $18.20
| Professional | | $9.12 | $9.12 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $25.70 / $28.18
| Professional | | $19.95 | $25.70 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $18.20 / $29.51
| Professional | | $15.14 | $18.20 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $18.20 / $22.91
| Professional | | $6.46 | $18.20 | $22.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $23.99 / $34.67
| Professional | | $17.38 | $23.99 | $34.67 |