- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $19.50 / $23.44
| Facility | | $16.22 | $19.50 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $18.20 / $18.20
| Professional | | $14.13 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $15.49 / $23.44
| Professional | | $15.49 | $15.49 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $35.48 / $38.90
| Professional | | $27.54 | $35.48 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $23.44 / $31.62
| Professional | | $19.50 | $23.44 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $27.54 / $38.02
| Professional | | $8.13 | $27.54 | $38.02 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $30.20 / $48.98
| Professional | | $9.55 | $30.20 | $48.98 |