- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.39 / $40.11 / $47.18
| Facility | | $35.39 | $40.11 | $47.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.39 / $37.19 / $214.03
| Professional | | $29.39 | $37.19 | $214.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.36 / $47.18 / $49.12
| Professional | | $29.36 | $47.18 | $49.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.14 / $101.52 / $111.10
| Professional | | $23.14 | $101.52 | $111.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.45 / $41.94 / $48.93
| Professional | | $38.45 | $41.94 | $48.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.83 / $47.18 / $52.99
| Professional | | $39.83 | $47.18 | $52.99 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.32 / $57.16 / $116.60
| Professional | | $36.32 | $57.16 | $116.60 |