- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $22.39 / $27.54
| Facility | | $18.62 | $22.39 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $19.95 / $21.88
| Professional | | $15.85 | $19.95 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $18.20 / $27.54
| Professional | | $18.20 | $18.20 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $50.12 / $56.23
| Professional | | $39.81 | $50.12 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $27.54 / $33.88
| Professional | | $22.91 | $27.54 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $31.62 / $44.67
| Professional | | $9.55 | $31.62 | $44.67 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $40.74 / $57.54
| Professional | | $25.70 | $40.74 | $57.54 |