- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.39 / $26.92 / $33.11
| Facility | | $22.39 | $26.92 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $20.89 / $25.70
| Professional | | $14.13 | $20.89 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $15.85 / $33.11
| Professional | | $15.85 | $15.85 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $44.67 / $48.98
| Professional | | $34.67 | $44.67 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $33.11 / $40.74
| Professional | | $27.54 | $33.11 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $33.11 / $40.74
| Professional | | $11.48 | $33.11 | $40.74 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $37.15 / $52.48
| Professional | | $29.51 | $37.15 | $52.48 |