- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.46 / $39.04 / $50.12
| Facility | | $34.46 | $39.04 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.86 / $57.36 / $94.56
| Professional | | $28.86 | $57.36 | $94.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.82 / $50.12 / $50.12
| Professional | | $19.82 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.61 / $53.57 / $62.68
| Professional | | $40.61 | $53.57 | $62.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.77 / $50.12 / $62.66
| Professional | | $41.77 | $50.12 | $62.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.54 / $50.12 / $62.66
| Professional | | $17.54 | $50.12 | $62.66 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.61 / $49.60 / $73.09
| Professional | | $36.61 | $49.60 | $73.09 |