- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $16.98 / $20.42
| Facility | | $14.13 | $16.98 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $14.79 / $15.85
| Professional | | $12.02 | $14.79 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $13.49 / $13.49
| Professional | | $13.49 | $13.49 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $38.02 / $41.69
| Professional | | $29.51 | $38.02 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $20.42 / $25.70
| Professional | | $16.98 | $20.42 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $23.99 / $25.70
| Professional | | $7.08 | $23.99 | $25.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $29.51 / $33.88
| Professional | | $25.12 | $29.51 | $33.88 |