- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.14 / $44.54 / $74.20
| Facility | | $40.14 | $44.54 | $74.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.23 / $26.64 / $66.00
| Professional | | $18.23 | $26.64 | $66.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.95 / $22.95 / $22.95
| Professional | | $22.95 | $22.95 | $22.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.41 / $22.41 / $22.41
| Professional | | $22.41 | $22.41 | $22.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.54 / $27.86 / $32.50
| Professional | | $25.54 | $27.86 | $32.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.14 / $26.82 / $31.31
| Professional | | $25.14 | $26.82 | $31.31 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.80 / $19.77 / $22.67
| Professional | | $16.80 | $19.77 | $22.67 |