- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.17 / $19.46 / $24.97
| Facility | | $17.17 | $19.46 | $24.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.48 / $24.97 / $24.97
| Professional | | $16.48 | $24.97 | $24.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.95 / $40.57 / $49.36
| Professional | | $31.95 | $40.57 | $49.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.81 / $24.97 / $31.22
| Professional | | $20.81 | $24.97 | $31.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.74 / $24.97 / $40.40
| Professional | | $8.74 | $24.97 | $40.40 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.10 / $30.59 / $46.82
| Professional | | $14.10 | $30.59 | $46.82 |