- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $40.74 / $186.21
| Facility | | $33.88 | $40.74 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $37.15 / $48.98
| Professional | | $30.20 | $37.15 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $33.11 / $48.98
| Professional | | $33.11 | $33.11 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $91.20 / $102.33
| Professional | | $70.79 | $91.20 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $48.98 / $61.66
| Professional | | $41.69 | $48.98 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $57.54 / $79.43
| Professional | | $17.38 | $57.54 | $79.43 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $74.13 / $104.71
| Professional | | $41.69 | $74.13 | $104.71 |