- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $28.18 / $33.88
| Facility | | $23.44 | $28.18 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $25.12 / $26.92
| Professional | | $6.03 | $25.12 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $20.89 / $33.88
| Professional | | $20.89 | $20.89 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $58.88 / $64.57
| Professional | | $45.71 | $58.88 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $33.88 / $42.66
| Professional | | $28.18 | $33.88 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $37.15 / $51.29
| Professional | | $12.02 | $37.15 | $51.29 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $47.86 / $66.07
| Professional | | $31.62 | $47.86 | $66.07 |