- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.96 / $18.09 / $23.22
| Facility | | $15.96 | $18.09 | $23.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.36 / $22.36 / $26.57
| Professional | | $22.36 | $22.36 | $26.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.31 / $23.22 / $23.22
| Professional | | $15.31 | $23.22 | $23.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.47 / $41.52 / $48.55
| Professional | | $31.47 | $41.52 | $48.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.35 / $23.22 / $29.03
| Professional | | $19.35 | $23.22 | $29.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $23.22 / $37.56
| Professional | | $8.13 | $23.22 | $37.56 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.67 / $35.15 / $48.67
| Professional | | $21.67 | $35.15 | $48.67 |