- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.73 / $18.96 / $24.34
| Facility | | $16.73 | $18.96 | $24.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.26 / $24.26 / $24.26
| Professional | | $24.26 | $24.26 | $24.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.10 / $24.34 / $24.34
| Professional | | $16.10 | $24.34 | $24.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.99 / $43.51 / $50.92
| Professional | | $32.99 | $43.51 | $50.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.28 / $24.34 / $30.42
| Professional | | $20.28 | $24.34 | $30.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.52 / $24.34 / $39.36
| Professional | | $8.52 | $24.34 | $39.36 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.71 / $36.84 / $51.01
| Professional | | $22.71 | $36.84 | $51.01 |