- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.85 / $25.02 / $81.62
| Facility | | $20.85 | $25.02 | $81.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.47 / $22.57 / $22.74
| Professional | | $22.47 | $22.57 | $22.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.02 / $30.32 / $30.32
| Professional | | $20.02 | $30.32 | $30.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.09 / $54.19 / $63.39
| Professional | | $41.09 | $54.19 | $63.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.27 / $30.32 / $37.90
| Professional | | $25.27 | $30.32 | $37.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.61 / $30.32 / $49.05
| Professional | | $10.61 | $30.32 | $49.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.30 / $45.90 / $63.56
| Professional | | $28.30 | $45.90 | $63.56 |