- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $36.31 / $43.65
| Facility | | $30.20 | $36.31 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $33.88 / $34.67
| Professional | | $26.92 | $33.88 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $28.84 / $43.65
| Professional | | $28.84 | $28.84 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $81.28 / $89.13
| Professional | | $63.10 | $81.28 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $43.65 / $54.95
| Professional | | $36.31 | $43.65 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $51.29 / $70.79
| Professional | | $15.49 | $51.29 | $70.79 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $66.07 / $91.20
| Professional | | $40.74 | $66.07 | $91.20 |