- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.54 / $16.48 / $21.16
| Facility | | $14.54 | $16.48 | $21.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.33 / $9.33 / $17.62
| Professional | | $9.33 | $9.33 | $17.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.94 / $21.16 / $21.16
| Professional | | $13.94 | $21.16 | $21.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.69 / $37.86 / $44.28
| Professional | | $28.69 | $37.86 | $44.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.63 / $21.16 / $26.45
| Professional | | $17.63 | $21.16 | $26.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.40 / $21.16 / $34.22
| Professional | | $7.40 | $21.16 | $34.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.75 / $32.03 / $44.35
| Professional | | $19.75 | $32.03 | $44.35 |