- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.83 / $16.80 / $21.58
| Facility | | $14.83 | $16.80 | $21.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.41 / $16.41 / $16.41
| Professional | | $16.41 | $16.41 | $16.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.33 / $21.58 / $21.58
| Professional | | $14.33 | $21.58 | $21.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.21 / $38.53 / $42.88
| Professional | | $29.21 | $38.53 | $42.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.98 / $21.58 / $26.97
| Professional | | $17.98 | $21.58 | $26.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.55 / $21.58 / $34.90
| Professional | | $7.55 | $21.58 | $34.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.28 / $32.64 / $45.54
| Professional | | $15.28 | $32.64 | $45.54 |