- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.59 / $27.86 / $35.76
| Facility | | $24.59 | $27.86 | $35.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.51 / $15.51 / $15.51
| Professional | | $15.51 | $15.51 | $15.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.90 / $35.76 / $35.76
| Professional | | $15.90 | $35.76 | $35.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.61 / $40.83 / $47.58
| Professional | | $32.61 | $40.83 | $47.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.78 / $35.76 / $41.72
| Professional | | $32.78 | $35.76 | $41.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.02 / $35.76 / $44.70
| Professional | | $28.02 | $35.76 | $44.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.42 / $37.25 / $52.15
| Professional | | $29.42 | $37.25 | $52.15 |