- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.01 / $30.56 / $185.21
| Facility | | $21.01 | $30.56 | $185.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.10 / $22.74 / $29.45
| Professional | | $19.10 | $22.74 | $29.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.22 / $30.56 / $30.56
| Professional | | $20.22 | $30.56 | $30.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.42 / $54.64 / $63.93
| Professional | | $41.42 | $54.64 | $63.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.47 / $30.56 / $38.21
| Professional | | $25.47 | $30.56 | $38.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.70 / $30.56 / $49.43
| Professional | | $10.70 | $30.56 | $49.43 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.47 / $45.89 / $64.03
| Professional | | $25.47 | $45.89 | $64.03 |