- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.55 / $29.51 / $36.31
| Facility | | $24.55 | $29.51 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $25.12 / $37.15
| Professional | | $14.13 | $25.12 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $15.85 / $36.31
| Professional | | $14.13 | $15.85 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $44.67 / $48.98
| Professional | | $34.67 | $44.67 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $36.31 / $44.67
| Professional | | $33.11 | $36.31 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $28.18 / $44.67
| Professional | | $14.13 | $28.18 | $44.67 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $37.15 / $52.48
| Professional | | $29.51 | $37.15 | $52.48 |