- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.19 / $16.07 / $20.64
| Facility | | $14.19 | $16.07 | $20.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.74 / $20.64 / $20.64
| Professional | | $13.74 | $20.64 | $20.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.99 / $36.92 / $43.20
| Professional | | $27.99 | $36.92 | $43.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.20 / $20.64 / $25.80
| Professional | | $17.20 | $20.64 | $25.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.22 / $20.64 / $33.40
| Professional | | $7.22 | $20.64 | $33.40 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.26 / $31.25 / $43.27
| Professional | | $19.26 | $31.25 | $43.27 |