- 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
- $6.03 / $15.85 / $15.85
| Professional | | $6.03 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $13.49 / $20.42
| Professional | | $13.49 | $13.49 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $38.02 / $42.66
| Professional | | $29.51 | $38.02 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $20.42 / $25.70
| Professional | | $17.38 | $20.42 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.24 / $23.99 / $33.11
| Professional | | $7.24 | $23.99 | $33.11 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $30.90 / $43.65
| Professional | | $19.05 | $30.90 | $43.65 |