- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.64 / $17.73 / $22.75
| Facility | | $15.64 | $17.73 | $22.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.03 / $20.86 / $47.84
| Professional | | $14.03 | $20.86 | $47.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.12 / $22.75 / $22.75
| Professional | | $15.12 | $22.75 | $22.75 |
- 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
- $18.96 / $22.75 / $28.44
| Professional | | $18.96 | $22.75 | $28.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.96 / $22.75 / $36.82
| Professional | | $7.96 | $22.75 | $36.82 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.96 / $34.20 / $47.72
| Professional | | $18.96 | $34.20 | $47.72 |