- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.67 / $18.89 / $24.24
| Facility | | $16.67 | $18.89 | $24.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.10 / $24.24 / $24.24
| Professional | | $16.10 | $24.24 | $24.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.98 / $21.15 / $23.58
| Professional | | $17.98 | $21.15 | $23.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.20 / $24.24 / $30.30
| Professional | | $20.20 | $24.24 | $30.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.48 / $24.24 / $30.30
| Professional | | $8.48 | $24.24 | $30.30 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.78 / $19.67 / $29.94
| Professional | | $13.78 | $19.67 | $29.94 |