- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $52.48 / $64.57
| Facility | | $43.65 | $52.48 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $44.67 / $67.61
| Professional | | $15.14 | $44.67 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $27.54 / $64.57
| Professional | | $24.55 | $27.54 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $85.11 / $85.11
| Professional | | $60.26 | $85.11 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $64.57 / $79.43
| Professional | | $58.88 | $64.57 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $48.98 / $79.43
| Professional | | $22.91 | $48.98 | $79.43 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $67.61 / $93.33
| Professional | | $51.29 | $67.61 | $93.33 |