- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.08 / $23.89 / $30.66
| Facility | | $21.08 | $23.89 | $30.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.82 / $30.66 / $30.66
| Professional | | $19.82 | $30.66 | $30.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $53.64 / $62.74
| Professional | | $40.65 | $53.64 | $62.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.55 / $30.66 / $38.33
| Professional | | $25.55 | $30.66 | $38.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.73 / $30.66 / $48.54
| Professional | | $10.73 | $30.66 | $48.54 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.62 / $45.42 / $62.89
| Professional | | $28.62 | $45.42 | $62.89 |