- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.63 / $27.91 / $35.82
| Facility | | $24.63 | $27.91 | $35.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.75 / $35.82 / $35.82
| Professional | | $23.75 | $35.82 | $35.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.54 / $64.01 / $74.97
| Professional | | $48.54 | $64.01 | $74.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.85 / $35.82 / $44.78
| Professional | | $29.85 | $35.82 | $44.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.54 / $35.82 / $57.94
| Professional | | $12.54 | $35.82 | $57.94 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.43 / $54.22 / $75.08
| Professional | | $33.43 | $54.22 | $75.08 |