- 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
- $3.98 / $23.99 / $83.18
| Professional | | $3.98 | $23.99 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $20.42 / $30.20
| Professional | | $20.42 | $20.42 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $56.23 / $63.10
| Professional | | $43.65 | $56.23 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $30.20 / $38.02
| Professional | | $25.70 | $30.20 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $35.48 / $48.98
| Professional | | $10.72 | $35.48 | $48.98 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $45.71 / $64.57
| Professional | | $28.18 | $45.71 | $64.57 |