- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.34 / $20.79 / $26.68
| Facility | | $18.34 | $20.79 | $26.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.11 / $20.10 / $52.65
| Professional | | $19.11 | $20.10 | $52.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.67 / $26.68 / $26.68
| Professional | | $17.67 | $26.68 | $26.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.14 / $47.67 / $55.80
| Professional | | $36.14 | $47.67 | $55.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.23 / $26.68 / $33.35
| Professional | | $22.23 | $26.68 | $33.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.34 / $26.68 / $43.16
| Professional | | $9.34 | $26.68 | $43.16 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.23 / $40.08 / $55.93
| Professional | | $22.23 | $40.08 | $55.93 |