- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.09 / $25.04 / $32.14
| Facility | | $22.09 | $25.04 | $32.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.34 / $23.34 / $23.87
| Professional | | $23.34 | $23.34 | $23.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.20 / $32.14 / $32.14
| Professional | | $21.20 | $32.14 | $32.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.40 / $38.78 / $45.44
| Professional | | $29.40 | $38.78 | $45.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.78 / $32.14 / $40.17
| Professional | | $26.78 | $32.14 | $40.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.25 / $32.14 / $40.17
| Professional | | $11.25 | $32.14 | $40.17 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.54 / $33.47 / $57.86
| Professional | | $26.54 | $33.47 | $57.86 |