- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.48 / $40.74 / $47.86
| Facility | | $35.48 | $40.74 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $30.90 / $50.12
| Professional | | $22.91 | $30.90 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $33.88 / $64.57
| Professional | | $25.70 | $33.88 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $47.86 / $52.48
| Professional | | $34.67 | $47.86 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $42.66 / $48.98
| Professional | | $38.90 | $42.66 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $43.65 / $67.61
| Professional | | $36.31 | $43.65 | $67.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $51.29 / $69.18
| Professional | | $32.36 | $51.29 | $69.18 |