- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.45 / $17.38 / $21.38
| Facility | | $14.45 | $17.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $15.85 / $16.98
| Professional | | $12.88 | $15.85 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $13.80 / $21.38
| Professional | | $13.80 | $13.80 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $38.90 / $43.65
| Professional | | $30.90 | $38.90 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $21.38 / $26.30
| Professional | | $17.78 | $21.38 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $24.55 / $34.67
| Professional | | $7.41 | $24.55 | $34.67 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $31.62 / $44.67
| Professional | | $19.95 | $31.62 | $44.67 |