- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.57 / $21.06 / $27.02
| Facility | | $18.57 | $21.06 | $27.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.86 / $27.02 / $27.02
| Professional | | $17.86 | $27.02 | $27.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.61 / $48.30 / $56.46
| Professional | | $36.61 | $48.30 | $56.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.52 / $27.02 / $33.78
| Professional | | $22.52 | $27.02 | $33.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.46 / $27.02 / $43.70
| Professional | | $9.46 | $27.02 | $43.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.22 / $40.89 / $56.61
| Professional | | $25.22 | $40.89 | $56.61 |