- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.17 / $18.32 / $23.52
| Facility | | $16.17 | $18.32 | $23.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.65 / $22.87 / $26.91
| Professional | | $22.65 | $22.87 | $26.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.51 / $23.52 / $23.52
| Professional | | $15.51 | $23.52 | $23.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.79 / $42.01 / $49.14
| Professional | | $33.79 | $42.01 | $49.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.60 / $23.52 / $29.40
| Professional | | $19.60 | $23.52 | $29.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.23 / $23.52 / $38.03
| Professional | | $8.23 | $23.52 | $38.03 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.95 / $35.58 / $49.27
| Professional | | $21.95 | $35.58 | $49.27 |