- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.66 / $20.02 / $25.69
| Facility | | $17.66 | $20.02 | $25.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.27 / $19.27 / $19.27
| Professional | | $19.27 | $19.27 | $19.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.07 / $25.69 / $25.69
| Professional | | $17.07 | $25.69 | $25.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.82 / $45.93 / $53.77
| Professional | | $34.82 | $45.93 | $53.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.41 / $25.69 / $32.11
| Professional | | $21.41 | $25.69 | $32.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.99 / $25.69 / $41.55
| Professional | | $8.99 | $25.69 | $41.55 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.41 / $38.60 / $53.86
| Professional | | $21.41 | $38.60 | $53.86 |