- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.92 / $15.77 / $20.23
| Facility | | $13.92 | $15.77 | $20.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.69 / $19.69 / $19.69
| Professional | | $19.69 | $19.69 | $19.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.35 / $20.23 / $20.23
| Professional | | $13.35 | $20.23 | $20.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.42 / $36.17 / $42.33
| Professional | | $27.42 | $36.17 | $42.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.87 / $20.23 / $25.31
| Professional | | $16.87 | $20.23 | $25.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.09 / $20.23 / $32.72
| Professional | | $7.09 | $20.23 | $32.72 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.89 / $30.41 / $42.43
| Professional | | $18.89 | $30.41 | $42.43 |