- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.11 / $52.26 / $67.06
| Facility | | $46.11 | $52.26 | $67.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.64 / $76.75 / $350.43
| Professional | | $64.64 | $76.75 | $350.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.20 / $67.06 / $67.06
| Professional | | $32.20 | $67.06 | $67.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.89 / $119.89 / $140.28
| Professional | | $90.89 | $119.89 | $140.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.89 / $67.06 / $83.84
| Professional | | $55.89 | $67.06 | $83.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.47 / $67.06 / $108.49
| Professional | | $23.47 | $67.06 | $108.49 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.60 / $101.50 / $140.54
| Professional | | $62.60 | $101.50 | $140.54 |