- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.72 / $24.72 / $24.72
| Facility | | $24.72 | $24.72 | $24.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.73 / $24.73 / $24.73
| Facility | | $24.73 | $24.73 | $24.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.34 / $14.34 / $14.34
| Professional | | $14.34 | $14.34 | $14.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.91 / $19.91 / $19.91
| Professional | | $19.91 | $19.91 | $19.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.77 / $17.20 / $20.07
| Professional | | $15.77 | $17.20 | $20.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.05 / $16.36 / $21.51
| Professional | | $16.05 | $16.36 | $21.51 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.75 / $12.62 / $16.50
| Professional | | $8.75 | $12.62 | $16.50 |