- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.49 / $18.62 / $22.91
| Facility | | $15.49 | $18.62 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $16.98 / $18.20
| Professional | | $14.13 | $16.98 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $15.14 / $22.91
| Professional | | $15.14 | $15.14 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $41.69 / $46.77
| Professional | | $32.36 | $41.69 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $22.91 / $28.18
| Professional | | $19.05 | $22.91 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $26.30 / $37.15
| Professional | | $7.94 | $26.30 | $37.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $33.88 / $47.86
| Professional | | $21.38 | $33.88 | $47.86 |