- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.49 / $18.62 / $22.39
| Facility | | $15.49 | $18.62 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $16.98 / $22.39
| Professional | | $12.88 | $16.98 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.79 / $14.79 / $22.39
| Professional | | $14.79 | $14.79 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $41.69 / $45.71
| Professional | | $32.36 | $41.69 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $22.39 / $30.90
| Professional | | $18.62 | $22.39 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $26.30 / $36.31
| Professional | | $7.94 | $26.30 | $36.31 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $33.88 / $46.77
| Professional | | $20.89 | $33.88 | $46.77 |