- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.42 / $25.40 / $32.60
| Facility | | $22.42 | $25.40 | $32.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.20 / $24.27 / $31.73
| Professional | | $24.20 | $24.27 | $31.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.59 / $32.60 / $32.60
| Professional | | $21.59 | $32.60 | $32.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.15 / $55.28 / $68.17
| Professional | | $44.15 | $55.28 | $68.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.17 / $32.60 / $40.76
| Professional | | $27.17 | $32.60 | $40.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.41 / $32.60 / $52.74
| Professional | | $11.41 | $32.60 | $52.74 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.43 / $49.34 / $68.31
| Professional | | $30.43 | $49.34 | $68.31 |