- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.80 / $16.60 / $20.42
| Facility | | $13.80 | $16.60 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $15.14 / $16.98
| Professional | | $3.98 | $15.14 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $13.49 / $20.42
| Professional | | $13.49 | $13.49 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $37.15 / $41.69
| Professional | | $28.84 | $37.15 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $20.42 / $25.12
| Professional | | $16.98 | $20.42 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $23.44 / $32.36
| Professional | | $7.08 | $23.44 | $32.36 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $30.20 / $42.66
| Professional | | $19.05 | $30.20 | $42.66 |