- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.72 / $20.07 / $25.78
| Facility | | $17.72 | $20.07 | $25.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.07 / $25.78 / $25.78
| Professional | | $17.07 | $25.78 | $25.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.92 / $46.06 / $53.89
| Professional | | $34.92 | $46.06 | $53.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.48 / $25.78 / $32.22
| Professional | | $21.48 | $25.78 | $32.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $25.78 / $41.71
| Professional | | $9.02 | $25.78 | $41.71 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.06 / $39.01 / $54.02
| Professional | | $24.06 | $39.01 | $54.02 |