- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.89 / $49.74 / $58.52
| Facility | | $43.89 | $49.74 | $58.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.40 / $38.75 / $38.75
| Professional | | $27.40 | $38.75 | $38.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.52 / $47.52 / $71.62
| Professional | | $47.52 | $47.52 | $71.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.16 / $59.73 / $70.48
| Professional | | $53.16 | $59.73 | $70.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.69 / $52.02 / $54.19
| Professional | | $47.69 | $52.02 | $54.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.52 / $60.61 / $68.72
| Professional | | $58.52 | $60.61 | $68.72 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.31 / $63.92 / $117.48
| Professional | | $45.31 | $63.92 | $117.48 |