- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.14 / $18.29 / $23.47
| Facility | | $16.14 | $18.29 | $23.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.61 / $26.86 / $78.23
| Professional | | $22.61 | $26.86 | $78.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.51 / $23.47 / $23.47
| Professional | | $15.51 | $23.47 | $23.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.73 / $33.93 / $49.07
| Professional | | $25.73 | $33.93 | $49.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.55 / $23.47 / $29.34
| Professional | | $19.55 | $23.47 | $29.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.22 / $23.47 / $37.97
| Professional | | $8.22 | $23.47 | $37.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.46 / $35.24 / $49.18
| Professional | | $9.46 | $35.24 | $49.18 |