- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.11 / $22.79 / $29.24
| Facility | | $20.11 | $22.79 | $29.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.16 / $29.16 / $29.16
| Professional | | $29.16 | $29.16 | $29.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.23 / $29.24 / $29.24
| Professional | | $19.23 | $29.24 | $29.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.63 / $52.27 / $61.17
| Professional | | $39.63 | $52.27 | $61.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.37 / $29.24 / $36.56
| Professional | | $24.37 | $29.24 | $36.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.24 / $29.24 / $47.31
| Professional | | $10.24 | $29.24 | $47.31 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.29 / $44.27 / $61.29
| Professional | | $27.29 | $44.27 | $61.29 |