- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.78 / $16.76 / $21.50
| Facility | | $14.78 | $16.76 | $21.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.07 / $19.69 / $82.55
| Professional | | $15.07 | $19.69 | $82.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.35 / $21.50 / $21.50
| Professional | | $13.35 | $21.50 | $21.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.42 / $34.34 / $42.33
| Professional | | $27.42 | $34.34 | $42.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.92 / $21.50 / $26.88
| Professional | | $17.92 | $21.50 | $26.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.53 / $21.50 / $32.75
| Professional | | $7.53 | $21.50 | $32.75 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.92 / $30.41 / $42.43
| Professional | | $17.92 | $30.41 | $42.43 |