- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.90 / $16.89 / $21.67
| Facility | | $14.90 | $16.89 | $21.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.88 / $21.67 / $31.43
| Professional | | $20.88 | $21.67 | $31.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.33 / $21.67 / $21.67
| Professional | | $14.33 | $21.67 | $21.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.36 / $38.72 / $45.33
| Professional | | $29.36 | $38.72 | $45.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.05 / $21.67 / $27.09
| Professional | | $18.05 | $21.67 | $27.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $21.67 / $35.06
| Professional | | $7.59 | $21.67 | $35.06 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.23 / $32.54 / $45.41
| Professional | | $20.23 | $32.54 | $45.41 |