- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.12 / $16.01 / $20.54
| Facility | | $14.12 | $16.01 | $20.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.07 / $9.07 / $17.12
| Professional | | $9.07 | $9.07 | $17.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $20.54 / $20.54
| Professional | | $13.55 | $20.54 | $20.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.85 / $36.74 / $42.98
| Professional | | $27.85 | $36.74 | $42.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.12 / $20.54 / $25.68
| Professional | | $17.12 | $20.54 | $25.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.19 / $20.54 / $33.25
| Professional | | $7.19 | $20.54 | $33.25 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.17 / $31.12 / $43.09
| Professional | | $19.17 | $31.12 | $43.09 |