- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.77 / $28.08 / $36.04
| Facility | | $24.77 | $28.08 | $36.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.42 / $23.42 / $23.42
| Professional | | $23.42 | $23.42 | $23.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.90 / $36.04 / $36.04
| Professional | | $15.90 | $36.04 | $36.04 |
- 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
- $33.03 / $36.04 / $42.04
| Professional | | $33.03 | $36.04 | $42.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.02 / $36.04 / $45.05
| Professional | | $28.02 | $36.04 | $45.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.42 / $37.54 / $52.55
| Professional | | $29.42 | $37.54 | $52.55 |