- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.39 / $36.71 / $47.11
| Facility | | $32.39 | $36.71 | $47.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.16 / $27.16 / $27.16
| Professional | | $27.16 | $27.16 | $27.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.88 / $47.11 / $47.11
| Professional | | $27.88 | $47.11 | $47.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.06 / $71.45 / $83.26
| Professional | | $57.06 | $71.45 | $83.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.19 / $47.11 / $54.96
| Professional | | $43.19 | $47.11 | $54.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.11 / $49.04 / $68.12
| Professional | | $47.11 | $49.04 | $68.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.26 / $63.26 / $88.34
| Professional | | $39.26 | $63.26 | $88.34 |