- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.74 / $46.77 / $54.95
| Facility | | $40.74 | $46.77 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $38.90 / $57.54
| Professional | | $26.92 | $38.90 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $44.67 / $67.61
| Professional | | $33.11 | $44.67 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $56.23 / $58.88
| Professional | | $39.81 | $56.23 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $48.98 / $56.23
| Professional | | $44.67 | $48.98 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $52.48 / $72.44
| Professional | | $43.65 | $52.48 | $72.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $58.88 / $79.43
| Professional | | $43.65 | $58.88 | $79.43 |