- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.45 / $16.98 / $20.89
| Facility | | $14.45 | $16.98 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $15.85 / $15.85
| Professional | | $12.02 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $13.80 / $20.89
| Professional | | $13.80 | $13.80 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $38.90 / $42.66
| Professional | | $30.20 | $38.90 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $20.89 / $26.30
| Professional | | $17.38 | $20.89 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.24 / $23.99 / $33.88
| Professional | | $7.24 | $23.99 | $33.88 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $31.62 / $43.65
| Professional | | $19.50 | $31.62 | $43.65 |