- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.54 / $19.88 / $25.51
| Facility | | $17.54 | $19.88 | $25.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.95 / $19.12 / $21.48
| Professional | | $18.95 | $19.12 | $21.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.88 / $25.51 / $25.51
| Professional | | $16.88 | $25.51 | $25.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.59 / $45.62 / $53.34
| Professional | | $34.59 | $45.62 | $53.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.26 / $25.51 / $31.89
| Professional | | $21.26 | $25.51 | $31.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.93 / $25.51 / $41.27
| Professional | | $8.93 | $25.51 | $41.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.26 / $38.31 / $53.46
| Professional | | $21.26 | $38.31 | $53.46 |