- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $40.74 / $56.23
| Facility | | $33.88 | $40.74 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $35.48 / $38.90
| Professional | | $30.20 | $35.48 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $48.98
| Professional | | $32.36 | $32.36 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $91.20 / $100.00
| Professional | | $70.79 | $91.20 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $48.98 / $61.66
| Professional | | $40.74 | $48.98 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $57.54 / $79.43
| Professional | | $16.98 | $57.54 | $79.43 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $74.13 / $102.33
| Professional | | $40.74 | $74.13 | $102.33 |