- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.68 / $22.68 / $22.68
| Facility | | $22.68 | $22.68 | $22.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.67 / $22.67 / $22.67
| Facility | | $22.67 | $22.67 | $22.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.30 / $15.30 / $15.30
| Professional | | $15.30 | $15.30 | $15.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.97 / $17.97 / $17.97
| Professional | | $17.97 | $17.97 | $17.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.82 / $18.36 / $21.42
| Professional | | $16.82 | $18.36 | $21.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.77 / $15.30 / $22.95
| Professional | | $14.77 | $15.30 | $22.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.49 / $10.68 / $16.93
| Professional | | $1.49 | $10.68 | $16.93 |