- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.65 / $18.78 / $22.76
| Facility | | $15.65 | $18.78 | $22.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.86 / $16.86 / $26.05
| Professional | | $16.86 | $16.86 | $26.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.12 / $22.76 / $22.76
| Professional | | $15.12 | $22.76 | $22.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.86 / $40.71 / $47.62
| Professional | | $30.86 | $40.71 | $47.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.97 / $22.76 / $28.46
| Professional | | $18.97 | $22.76 | $28.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.97 / $22.76 / $36.82
| Professional | | $7.97 | $22.76 | $36.82 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.25 / $34.46 / $47.72
| Professional | | $21.25 | $34.46 | $47.72 |