- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $40.74 / $48.98
| Facility | | $33.88 | $40.74 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $34.67 / $51.29
| Professional | | $15.85 | $34.67 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $21.38 / $48.98
| Professional | | $19.05 | $21.38 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $58.88 / $66.07
| Professional | | $45.71 | $58.88 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $48.98 / $61.66
| Professional | | $44.67 | $48.98 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $47.86 / $61.66
| Professional | | $22.39 | $47.86 | $61.66 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $50.12 / $70.79
| Professional | | $38.02 | $50.12 | $70.79 |