- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.49 / $27.75 / $35.61
| Facility | | $24.49 | $27.75 | $35.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.56 / $35.61 / $35.61
| Professional | | $23.56 | $35.61 | $35.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.25 / $63.64 / $74.48
| Professional | | $48.25 | $63.64 | $74.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.68 / $35.61 / $44.52
| Professional | | $29.68 | $35.61 | $44.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.47 / $35.61 / $57.61
| Professional | | $12.47 | $35.61 | $57.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.24 / $53.91 / $74.65
| Professional | | $33.24 | $53.91 | $74.65 |