- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $52.48 / $58.88
| Facility | | $43.65 | $52.48 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $33.88 / $57.54
| Professional | | $26.92 | $33.88 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $58.88 / $83.18
| Professional | | $47.86 | $58.88 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $61.66 / $70.79
| Professional | | $53.70 | $61.66 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $54.95 / $63.10
| Professional | | $50.12 | $54.95 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.26 / $69.18
| Professional | | $32.36 | $60.26 | $69.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $64.57 / $102.33
| Professional | | $45.71 | $64.57 | $102.33 |