- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $30.20 / $51.29
| Professional | | $18.20 | $30.20 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $30.90 / $42.66
| Professional | | $20.89 | $30.90 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $61.66 / $74.13
| Professional | | $52.48 | $61.66 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $31.62 / $39.81
| Professional | | $16.98 | $31.62 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $33.11 / $63.10
| Professional | | $15.85 | $33.11 | $63.10 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $29.51 / $63.10
| Professional | | $15.85 | $29.51 | $63.10 |