- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.07 / $14.81 / $19.01
| Facility | | $13.07 | $14.81 | $19.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.51 / $18.51 / $18.51
| Professional | | $18.51 | $18.51 | $18.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.56 / $19.01 / $19.01
| Professional | | $12.56 | $19.01 | $19.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.78 / $34.00 / $39.76
| Professional | | $25.78 | $34.00 | $39.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.84 / $19.01 / $23.76
| Professional | | $15.84 | $19.01 | $23.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.65 / $19.01 / $30.75
| Professional | | $6.65 | $19.01 | $30.75 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.73 / $28.78 / $39.85
| Professional | | $17.73 | $28.78 | $39.85 |