- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.98 / $20.42 / $24.55
| Facility | | $16.98 | $20.42 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $15.14 / $19.05
| Professional | | $6.03 | $15.14 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $7.08 / $24.55
| Professional | | $7.08 | $7.08 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $25.70 / $28.18
| Professional | | $20.42 | $25.70 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $24.55 / $30.90
| Professional | | $20.42 | $24.55 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.51 / $17.38 / $30.90
| Professional | | $8.51 | $17.38 | $30.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $19.95 / $31.62
| Professional | | $13.80 | $19.95 | $31.62 |