- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.47 / $18.48 / $22.42
| Facility | | $17.47 | $18.48 | $22.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.46 / $25.65 / $28.95
| Professional | | $21.46 | $25.65 | $28.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.92 / $14.92 / $14.92
| Professional | | $14.92 | $14.92 | $14.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.39 / $40.09 / $46.91
| Professional | | $30.39 | $40.09 | $46.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.68 / $22.42 / $28.02
| Professional | | $18.68 | $22.42 | $28.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.85 / $22.42 / $36.28
| Professional | | $7.85 | $22.42 | $36.28 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.42 / $32.29 / $36.15
| Professional | | $27.42 | $32.29 | $36.15 |