- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.16 / $16.04 / $20.59
| Facility | | $14.16 | $16.04 | $20.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $20.59 / $20.59
| Professional | | $13.55 | $20.59 | $20.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.89 / $36.79 / $43.06
| Professional | | $27.89 | $36.79 | $43.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.16 / $20.59 / $25.74
| Professional | | $17.16 | $20.59 | $25.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.21 / $20.59 / $33.32
| Professional | | $7.21 | $20.59 | $33.32 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.22 / $30.93 / $43.16
| Professional | | $19.22 | $30.93 | $43.16 |