- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $33.88 / $41.69
| Facility | | $28.18 | $33.88 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $32.36 / $52.48
| Professional | | $25.12 | $32.36 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $27.54 / $41.69
| Professional | | $24.55 | $27.54 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $42.66 / $47.86
| Professional | | $34.67 | $42.66 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $41.69 / $51.29
| Professional | | $38.02 | $41.69 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $28.18 / $61.66
| Professional | | $18.62 | $28.18 | $61.66 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $23.44 / $53.70
| Professional | | $14.45 | $23.44 | $53.70 |