- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.88 / $19.13 / $24.55
| Facility | | $16.88 | $19.13 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.43 / $10.43 / $28.09
| Professional | | $10.43 | $10.43 | $28.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.07 / $24.55 / $24.55
| Professional | | $7.07 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.21 / $21.39 / $23.71
| Professional | | $18.21 | $21.39 | $23.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.46 / $24.55 / $28.64
| Professional | | $20.46 | $24.55 | $28.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.59 / $24.55 / $30.69
| Professional | | $8.59 | $24.55 | $30.69 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.86 / $19.78 / $30.09
| Professional | | $13.86 | $19.78 | $30.09 |