- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.86 / $36.11 / $46.34
| Facility | | $31.86 | $36.11 | $46.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.17 / $33.17 / $53.03
| Professional | | $33.17 | $33.17 | $53.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.62 / $46.34 / $46.34
| Professional | | $30.62 | $46.34 | $46.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.81 / $82.85 / $96.94
| Professional | | $62.81 | $82.85 | $96.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.61 / $46.34 / $57.93
| Professional | | $38.61 | $46.34 | $57.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $46.34 / $74.97
| Professional | | $16.22 | $46.34 | $74.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.61 / $69.62 / $97.15
| Professional | | $38.61 | $69.62 | $97.15 |