- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.85 / $19.09 / $24.50
| Facility | | $16.85 | $19.09 | $24.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.10 / $24.50 / $24.50
| Professional | | $16.10 | $24.50 | $24.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.22 / $43.82 / $51.24
| Professional | | $33.22 | $43.82 | $51.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $24.50 / $30.63
| Professional | | $20.42 | $24.50 | $30.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.58 / $24.50 / $39.64
| Professional | | $8.58 | $24.50 | $39.64 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.87 / $37.09 / $51.35
| Professional | | $22.87 | $37.09 | $51.35 |