- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $16.98 / $20.42
| Facility | | $14.13 | $16.98 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $15.14 / $15.85
| Professional | | $10.96 | $15.14 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $12.88 / $20.42
| Professional | | $12.88 | $12.88 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $35.48 / $39.81
| Professional | | $27.54 | $35.48 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $20.42 / $25.70
| Professional | | $16.98 | $20.42 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.24 / $22.39 / $30.90
| Professional | | $7.24 | $22.39 | $30.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $28.84 / $40.74
| Professional | | $19.05 | $28.84 | $40.74 |