- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.45 / $17.38 / $20.89
| Facility | | $14.45 | $17.38 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $12.88 / $15.85
| Professional | | $3.98 | $12.88 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $7.59 / $20.89
| Professional | | $7.59 | $7.59 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $21.88 / $23.44
| Professional | | $17.38 | $21.88 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $20.89 / $26.30
| Professional | | $17.38 | $20.89 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $18.62 / $26.30
| Professional | | $7.41 | $18.62 | $26.30 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $20.42 / $30.90
| Professional | | $14.45 | $20.42 | $30.90 |