- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.07 / $20.50 / $26.30
| Facility | | $18.07 | $20.50 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.51 / $15.51 / $15.51
| Professional | | $15.51 | $15.51 | $15.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.90 / $26.30 / $26.30
| Professional | | $15.90 | $26.30 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.61 / $40.83 / $47.58
| Professional | | $32.61 | $40.83 | $47.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.11 / $26.30 / $30.69
| Professional | | $24.11 | $26.30 | $30.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $28.02 / $38.93
| Professional | | $26.30 | $28.02 | $38.93 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $36.15 / $50.44
| Professional | | $24.55 | $36.15 | $50.44 |