- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.17 / $17.19 / $22.07
| Facility | | $15.17 | $17.19 | $22.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.53 / $22.07 / $22.07
| Professional | | $14.53 | $22.07 | $22.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.93 / $39.47 / $46.15
| Professional | | $29.93 | $39.47 | $46.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.39 / $22.07 / $27.59
| Professional | | $18.39 | $22.07 | $27.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.72 / $22.07 / $35.71
| Professional | | $7.72 | $22.07 | $35.71 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.60 / $33.40 / $46.26
| Professional | | $20.60 | $33.40 | $46.26 |