- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.20 / $41.04 / $45.60
| Facility | | $34.20 | $41.04 | $45.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.05 / $33.54 / $56.05
| Professional | | $28.05 | $33.54 | $56.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.40 / $35.40 / $35.40
| Facility | | $35.40 | $35.40 | $35.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.29 / $33.79 / $45.60
| Professional | | $28.29 | $33.79 | $45.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $35.69 / $47.71
| Professional | | $9.42 | $35.69 | $47.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $40.54 / $47.29
| Professional | | $37.15 | $40.54 | $47.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.54 / $45.60 / $50.91
| Professional | | $16.54 | $45.60 | $50.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.47 / $50.80 / $70.27
| Professional | | $31.47 | $50.80 | $70.27 |