- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.06 / $23.87 / $30.64
| Facility | | $21.06 | $23.87 | $30.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.24 / $22.24 / $35.06
| Professional | | $22.24 | $22.24 | $35.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.22 / $30.64 / $30.64
| Professional | | $20.22 | $30.64 | $30.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.52 / $54.76 / $64.06
| Professional | | $41.52 | $54.76 | $64.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.53 / $30.64 / $38.29
| Professional | | $25.53 | $30.64 | $38.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $30.64 / $49.56
| Professional | | $10.72 | $30.64 | $49.56 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.59 / $46.37 / $64.20
| Professional | | $28.59 | $46.37 | $64.20 |