- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.61 / $31.29 / $40.15
| Facility | | $27.61 | $31.29 | $40.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.42 / $19.42 / $19.42
| Professional | | $19.42 | $19.42 | $19.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.82 / $40.15 / $40.15
| Professional | | $19.82 | $40.15 | $40.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.30 / $51.09 / $59.54
| Professional | | $43.30 | $51.09 | $59.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.82 / $40.15 / $46.86
| Professional | | $36.82 | $40.15 | $46.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.15 / $50.21 / $50.21
| Professional | | $40.15 | $50.21 | $50.21 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.54 / $45.59 / $64.88
| Professional | | $35.54 | $45.59 | $64.88 |