- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.39 / $26.92 / $32.36
| Facility | | $22.39 | $26.92 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $20.89 / $25.70
| Professional | | $12.88 | $20.89 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $13.49 / $32.36
| Professional | | $13.49 | $13.49 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $39.81 / $44.67
| Professional | | $30.90 | $39.81 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $32.36 / $40.74
| Professional | | $26.92 | $32.36 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $32.36 / $40.74
| Professional | | $11.48 | $32.36 | $40.74 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $36.31 / $60.26
| Professional | | $22.91 | $36.31 | $60.26 |