- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.21 / $29.06 / $87.81
| Facility | | $24.21 | $29.06 | $87.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.29 / $33.94 / $40.29
| Professional | | $32.29 | $33.94 | $40.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.74 / $35.22 / $35.22
| Professional | | $33.74 | $35.22 | $35.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.31 / $52.41 / $68.83
| Professional | | $31.31 | $52.41 | $68.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.35 / $35.22 / $41.09
| Professional | | $29.35 | $35.22 | $41.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.33 / $35.22 / $56.96
| Professional | | $12.33 | $35.22 | $56.96 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.95 / $53.30 / $73.80
| Professional | | $24.95 | $53.30 | $73.80 |