- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.01 / $18.14 / $23.28
| Facility | | $16.01 | $18.14 | $23.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.31 / $23.28 / $23.28
| Professional | | $15.31 | $23.28 | $23.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.57 / $41.64 / $48.67
| Professional | | $31.57 | $41.64 | $48.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.39 / $23.28 / $29.10
| Professional | | $19.39 | $23.28 | $29.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.15 / $23.28 / $37.65
| Professional | | $8.15 | $23.28 | $37.65 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.73 / $35.24 / $48.80
| Professional | | $21.73 | $35.24 | $48.80 |