- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $50.12 / $69.18
| Facility | | $41.69 | $50.12 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $45.71 / $47.86
| Professional | | $38.90 | $45.71 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $61.66
| Professional | | $39.81 | $39.81 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $63.10 / $69.18
| Professional | | $51.29 | $63.10 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $61.66 / $75.86
| Professional | | $51.29 | $61.66 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $61.66 / $75.86
| Professional | | $21.38 | $61.66 | $75.86 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $52.48 / $79.43
| Professional | | $36.31 | $52.48 | $79.43 |