- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.90 / $37.15 / $45.71
| Facility | | $30.90 | $37.15 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $33.88 / $36.31
| Professional | | $10.00 | $33.88 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $29.51 / $45.71
| Professional | | $29.51 | $29.51 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $83.18 / $93.33
| Professional | | $64.57 | $83.18 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $45.71 / $56.23
| Professional | | $38.02 | $45.71 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $52.48 / $72.44
| Professional | | $15.85 | $52.48 | $72.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $69.18 / $95.50
| Professional | | $42.66 | $69.18 | $95.50 |