- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.72 / $31.72 / $31.72
| Facility | | $31.72 | $31.72 | $31.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.71 / $31.71 / $31.71
| Facility | | $31.71 | $31.71 | $31.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.20 / $16.20 / $16.20
| Professional | | $16.20 | $16.20 | $16.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.00 / $24.00 / $24.00
| Professional | | $24.00 | $24.00 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.82 / $19.44 / $22.68
| Professional | | $17.82 | $19.44 | $22.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.20 / $19.72 / $24.30
| Professional | | $16.20 | $19.72 | $24.30 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.14 / $16.96 / $19.89
| Professional | | $13.14 | $16.96 | $19.89 |