- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.79 / $17.78 / $21.38
| Facility | | $14.79 | $17.78 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $15.85 / $16.98
| Professional | | $12.88 | $15.85 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $14.13 / $21.38
| Professional | | $14.13 | $14.13 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $39.81 / $43.65
| Professional | | $30.90 | $39.81 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $21.38 / $26.92
| Professional | | $17.78 | $21.38 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $25.12 / $34.67
| Professional | | $7.59 | $25.12 | $34.67 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $32.36 / $44.67
| Professional | | $19.95 | $32.36 | $44.67 |