- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.38 / $25.70 / $31.62
| Facility | | $21.38 | $25.70 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $23.99 / $39.81
| Professional | | $19.05 | $23.99 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $20.42 / $31.62
| Professional | | $18.62 | $20.42 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $57.54 / $64.57
| Professional | | $44.67 | $57.54 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $31.62 / $38.90
| Professional | | $28.84 | $31.62 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $31.62 / $50.12
| Professional | | $11.48 | $31.62 | $50.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $46.77 / $66.07
| Professional | | $29.51 | $46.77 | $66.07 |