- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.68 / $18.91 / $24.26
| Facility | | $16.68 | $18.91 | $24.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.10 / $24.26 / $24.26
| Professional | | $16.10 | $24.26 | $24.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.89 / $43.38 / $50.72
| Professional | | $32.89 | $43.38 | $50.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.22 / $24.26 / $30.33
| Professional | | $20.22 | $24.26 | $30.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.49 / $24.26 / $39.24
| Professional | | $8.49 | $24.26 | $39.24 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.65 / $36.71 / $50.83
| Professional | | $22.65 | $36.71 | $50.83 |