- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.89 / $25.12 / $30.20
| Facility | | $20.89 | $25.12 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $21.88 / $23.99
| Professional | | $16.98 | $21.88 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $18.62 / $30.20
| Professional | | $18.62 | $18.62 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $52.48 / $57.54
| Professional | | $40.74 | $52.48 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $30.20 / $38.02
| Professional | | $25.12 | $30.20 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $33.11 / $45.71
| Professional | | $10.47 | $33.11 | $45.71 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $42.66 / $58.88
| Professional | | $28.18 | $42.66 | $58.88 |