- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.38 / $20.89 / $25.12
| Facility | | $17.38 | $20.89 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $19.05 / $19.95
| Professional | | $15.14 | $19.05 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $16.60 / $25.12
| Professional | | $16.60 | $16.60 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $51.29 / $51.29
| Professional | | $36.31 | $51.29 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $25.12 / $31.62
| Professional | | $20.89 | $25.12 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $29.51 / $40.74
| Professional | | $8.91 | $29.51 | $40.74 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $38.02 / $52.48
| Professional | | $23.44 | $38.02 | $52.48 |