- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.64 / $16.64 / $20.17
| Facility | | $16.64 | $16.64 | $20.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $10.84 / $36.76
| Professional | | $10.74 | $10.84 | $36.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $9.42 / $9.42
| Professional | | $9.42 | $9.42 | $9.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.51 / $25.73 / $30.11
| Professional | | $19.51 | $25.73 | $30.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.80 / $20.17 / $23.53
| Professional | | $16.80 | $20.17 | $23.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.06 / $20.17 / $25.22
| Professional | | $7.06 | $20.17 | $25.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.23 / $23.21 / $31.01
| Professional | | $18.23 | $23.21 | $31.01 |