- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.55 / $29.51 / $35.48
| Facility | | $24.55 | $29.51 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $26.92 / $28.18
| Professional | | $21.88 | $26.92 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $23.44 / $35.48
| Professional | | $23.44 | $23.44 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $66.07 / $72.44
| Professional | | $51.29 | $66.07 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $35.48 / $44.67
| Professional | | $29.51 | $35.48 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $41.69 / $57.54
| Professional | | $12.59 | $41.69 | $57.54 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $53.70 / $74.13
| Professional | | $33.11 | $53.70 | $74.13 |