- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.78 / $31.78 / $31.78
| Facility | | $31.78 | $31.78 | $31.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.77 / $31.77 / $31.77
| Facility | | $31.77 | $31.77 | $31.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.14 / $18.14 / $18.14
| Professional | | $18.14 | $18.14 | $18.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.83 / $25.83 / $25.83
| Professional | | $25.83 | $25.83 | $25.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.97 / $21.78 / $25.41
| Professional | | $19.97 | $21.78 | $25.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.32 / $21.22 / $27.23
| Professional | | $20.32 | $21.22 | $27.23 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.04 / $20.05 / $22.82
| Professional | | $16.04 | $20.05 | $22.82 |