- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.81 / $77.20 / $285.18
| Facility | | $32.81 | $77.20 | $285.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.81 / $35.09 / $63.66
| Professional | | $22.81 | $35.09 | $63.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.88 / $42.11 / $42.11
| Professional | | $27.88 | $42.11 | $42.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.55 / $71.45 / $83.26
| Professional | | $60.55 | $71.45 | $83.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.60 / $42.11 / $49.13
| Professional | | $38.60 | $42.11 | $49.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.11 / $49.04 / $68.12
| Professional | | $42.11 | $49.04 | $68.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.09 / $63.26 / $88.27
| Professional | | $35.09 | $63.26 | $88.27 |