- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.96 / $18.09 / $23.22
| Facility | | $15.96 | $18.09 | $23.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.87 / $17.55 / $42.49
| Professional | | $16.87 | $17.55 | $42.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.31 / $23.22 / $23.22
| Professional | | $15.31 | $23.22 | $23.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.47 / $41.52 / $48.60
| Professional | | $31.47 | $41.52 | $48.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.35 / $23.22 / $27.09
| Professional | | $19.35 | $23.22 | $27.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $23.22 / $37.58
| Professional | | $8.13 | $23.22 | $37.58 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.35 / $34.89 / $48.69
| Professional | | $19.35 | $34.89 | $48.69 |