- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.56 / $28.97 / $37.18
| Facility | | $25.56 | $28.97 | $37.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.54 / $37.18 / $37.18
| Professional | | $24.54 | $37.18 | $37.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.37 / $66.44 / $77.75
| Professional | | $50.37 | $66.44 | $77.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.98 / $37.18 / $46.47
| Professional | | $30.98 | $37.18 | $46.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.01 / $37.18 / $60.14
| Professional | | $13.01 | $37.18 | $60.14 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.70 / $56.26 / $77.90
| Professional | | $34.70 | $56.26 | $77.90 |