- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.16 / $18.32 / $23.51
| Facility | | $16.16 | $18.32 | $23.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.69 / $23.51 / $23.51
| Professional | | $16.69 | $23.51 | $23.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.11 / $45.00 / $52.66
| Professional | | $34.11 | $45.00 | $52.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.59 / $23.51 / $29.39
| Professional | | $19.59 | $23.51 | $29.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.23 / $23.51 / $40.70
| Professional | | $8.23 | $23.51 | $40.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.64 / $28.80 / $51.28
| Professional | | $16.64 | $28.80 | $51.28 |