- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.19 / $18.35 / $23.56
| Facility | | $16.19 | $18.35 | $23.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.51 / $23.56 / $23.56
| Professional | | $15.51 | $23.56 | $23.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.13 / $38.25 / $46.55
| Professional | | $30.13 | $38.25 | $46.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.63 / $23.56 / $29.45
| Professional | | $19.63 | $23.56 | $29.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.24 / $23.56 / $38.10
| Professional | | $8.24 | $23.56 | $38.10 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.05 / $35.65 / $49.36
| Professional | | $13.05 | $35.65 | $49.36 |