- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.93 / $19.19 / $24.62
| Facility | | $16.93 | $19.19 | $24.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.29 / $24.62 / $24.62
| Professional | | $16.29 | $24.62 | $24.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.36 / $44.00 / $51.52
| Professional | | $33.36 | $44.00 | $51.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.52 / $24.62 / $30.78
| Professional | | $20.52 | $24.62 | $30.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.61 / $24.62 / $39.84
| Professional | | $8.61 | $24.62 | $39.84 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.98 / $37.28 / $51.62
| Professional | | $22.98 | $37.28 | $51.62 |