- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.85 / $36.10 / $42.47
| Facility | | $31.85 | $36.10 | $42.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.14 / $24.89 / $51.97
| Professional | | $20.14 | $24.89 | $51.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.79 / $32.79 / $32.79
| Facility | | $32.79 | $32.79 | $32.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.39 / $34.20 / $42.47
| Professional | | $29.39 | $34.20 | $42.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $37.81 / $43.39
| Professional | | $10.48 | $37.81 | $43.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.61 / $37.75 / $44.04
| Professional | | $34.61 | $37.75 | $44.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.81 / $42.47 / $48.27
| Professional | | $15.81 | $42.47 | $48.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.56 / $46.78 / $67.18
| Professional | | $32.56 | $46.78 | $67.18 |