- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.38 / $20.89 / $25.12
| Facility | | $17.38 | $20.89 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $18.20 / $19.95
| Professional | | $14.13 | $18.20 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $15.14 / $25.12
| Professional | | $15.14 | $15.14 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $41.69 / $46.77
| Professional | | $32.36 | $41.69 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $25.12 / $31.62
| Professional | | $20.89 | $25.12 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $26.30 / $37.15
| Professional | | $8.91 | $26.30 | $37.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $33.88 / $47.86
| Professional | | $23.44 | $33.88 | $47.86 |