- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.76 / $43.93 / $56.38
| Facility | | $38.76 | $43.93 | $56.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.28 / $42.60 / $46.98
| Professional | | $42.28 | $42.60 | $46.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.29 / $56.38 / $56.38
| Professional | | $37.29 | $56.38 | $56.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.43 / $100.81 / $117.96
| Professional | | $76.43 | $100.81 | $117.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.98 / $56.38 / $70.47
| Professional | | $46.98 | $56.38 | $70.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.73 / $56.38 / $91.21
| Professional | | $19.73 | $56.38 | $91.21 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.62 / $85.35 / $118.17
| Professional | | $52.62 | $85.35 | $118.17 |