- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.18 / $27.82 / $33.72
| Facility | | $23.18 | $27.82 | $33.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.28 / $25.47 / $32.50
| Professional | | $25.28 | $25.47 | $32.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.38 / $33.72 / $33.72
| Professional | | $22.38 | $33.72 | $33.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.01 / $40.89 / $47.91
| Professional | | $31.01 | $40.89 | $47.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.10 / $33.72 / $42.15
| Professional | | $28.10 | $33.72 | $42.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.80 / $33.72 / $42.15
| Professional | | $11.80 | $33.72 | $42.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.98 / $35.71 / $60.71
| Professional | | $27.98 | $35.71 | $60.71 |