- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.45 / $22.04 / $28.28
| Facility | | $19.45 | $22.04 | $28.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.78 / $11.78 / $23.57
| Professional | | $11.78 | $11.78 | $23.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.71 / $28.28 / $28.28
| Professional | | $15.71 | $28.28 | $28.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.59 / $39.03 / $45.70
| Professional | | $29.59 | $39.03 | $45.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.57 / $28.28 / $35.36
| Professional | | $23.57 | $28.28 | $35.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.90 / $28.28 / $35.36
| Professional | | $9.90 | $28.28 | $35.36 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.57 / $33.06 / $47.05
| Professional | | $23.57 | $33.06 | $47.05 |