- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.25 / $18.42 / $23.64
| Facility | | $16.25 | $18.42 | $23.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.92 / $23.64 / $27.05
| Professional | | $22.92 | $23.64 | $27.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.51 / $23.64 / $23.64
| Professional | | $15.51 | $23.64 | $23.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.39 / $30.96 / $37.68
| Professional | | $24.39 | $30.96 | $37.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.70 / $23.64 / $29.55
| Professional | | $19.70 | $23.64 | $29.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.27 / $23.64 / $38.10
| Professional | | $8.27 | $23.64 | $38.10 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.75 / $36.14 / $49.36
| Professional | | $16.75 | $36.14 | $49.36 |