- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.52 / $35.72 / $43.78
| Facility | | $31.52 | $35.72 | $43.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.81 / $55.81 / $55.81
| Professional | | $55.81 | $55.81 | $55.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.07 / $43.78 / $43.78
| Professional | | $16.07 | $43.78 | $43.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.29 / $44.80 / $49.56
| Professional | | $38.29 | $44.80 | $49.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.52 / $42.02 / $49.03
| Professional | | $38.52 | $42.02 | $49.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.49 / $43.78 / $54.75
| Professional | | $34.49 | $43.78 | $54.75 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $41.69 / $51.39
| Professional | | $7.76 | $41.69 | $51.39 |