- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.77 / $16.73 / $21.48
| Facility | | $14.77 | $16.73 | $21.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.94 / $21.48 / $21.48
| Professional | | $13.94 | $21.48 | $21.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.46 / $37.54 / $44.00
| Professional | | $28.46 | $37.54 | $44.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.89 / $21.48 / $26.85
| Professional | | $17.89 | $21.48 | $26.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.52 / $21.48 / $34.01
| Professional | | $7.52 | $21.48 | $34.01 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.05 / $31.81 / $44.05
| Professional | | $20.05 | $31.81 | $44.05 |