- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $50.12 / $60.26
| Facility | | $41.69 | $50.12 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $46.77 / $47.86
| Professional | | $25.12 | $46.77 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $36.31 / $60.26
| Professional | | $36.31 | $36.31 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $112.20 / $123.03
| Professional | | $87.10 | $112.20 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $60.26 / $75.86
| Professional | | $50.12 | $60.26 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $70.79 / $97.72
| Professional | | $21.38 | $70.79 | $97.72 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $91.20 / $125.89
| Professional | | $56.23 | $91.20 | $125.89 |