- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.65 / $24.53 / $31.49
| Facility | | $21.65 | $24.53 | $31.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.64 / $31.49 / $31.49
| Professional | | $18.64 | $31.49 | $31.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.36 / $50.59 / $59.18
| Professional | | $38.36 | $50.59 | $59.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.24 / $31.49 / $39.36
| Professional | | $26.24 | $31.49 | $39.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.02 / $31.49 / $45.77
| Professional | | $11.02 | $31.49 | $45.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.39 / $42.84 / $59.31
| Professional | | $29.39 | $42.84 | $59.31 |