- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $33.88 / $40.74
| Facility | | $28.18 | $33.88 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $30.90 / $32.36
| Professional | | $25.12 | $30.90 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $26.92 / $40.74
| Professional | | $26.92 | $26.92 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $83.18 / $83.18
| Professional | | $58.88 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $40.74 / $51.29
| Professional | | $33.88 | $40.74 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $47.86 / $66.07
| Professional | | $14.13 | $47.86 | $66.07 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $61.66 / $85.11
| Professional | | $28.84 | $61.66 | $85.11 |