- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.98 / $20.42 / $25.12
| Facility | | $16.98 | $20.42 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $19.05 / $29.51
| Professional | | $15.85 | $19.05 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $16.60 / $25.12
| Professional | | $16.60 | $16.60 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $45.71 / $51.29
| Professional | | $36.31 | $45.71 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $25.12 / $30.90
| Professional | | $20.89 | $25.12 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $28.84 / $40.74
| Professional | | $8.71 | $28.84 | $40.74 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $37.15 / $52.48
| Professional | | $20.89 | $37.15 | $52.48 |