- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.51 / $25.52 / $32.75
| Facility | | $22.51 | $25.52 | $32.75 |
- 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 / $32.75 / $32.75
| Professional | | $15.90 | $32.75 | $32.75 |
- 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
- $30.02 / $32.75 / $38.21
| Professional | | $30.02 | $32.75 | $38.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.02 / $32.75 / $40.94
| Professional | | $28.02 | $32.75 | $40.94 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.42 / $36.92 / $51.84
| Professional | | $29.42 | $36.92 | $51.84 |