- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.20 / $20.20 / $80.80
| Facility | | $20.20 | $20.20 | $80.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.21 / $20.21 / $20.21
| Facility | | $20.21 | $20.21 | $20.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.01 / $9.01 / $9.01
| Professional | | $9.01 | $9.01 | $9.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.63 / $12.63 / $12.63
| Professional | | $12.63 | $12.63 | $12.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.92 / $10.82 / $12.62
| Professional | | $9.92 | $10.82 | $12.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $10.38 / $13.53
| Professional | | $9.02 | $10.38 | $13.53 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.09 / $10.26 / $12.83
| Professional | | $4.09 | $10.26 | $12.83 |