- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.16 / $27.38 / $35.14
| Facility | | $24.16 | $27.38 | $35.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.16 / $35.14 / $35.14
| Professional | | $23.16 | $35.14 | $35.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.59 / $62.77 / $73.45
| Professional | | $47.59 | $62.77 | $73.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.28 / $35.14 / $43.92
| Professional | | $29.28 | $35.14 | $43.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $35.14 / $56.83
| Professional | | $12.30 | $35.14 | $56.83 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.79 / $53.17 / $73.62
| Professional | | $32.79 | $53.17 | $73.62 |