- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.48 / $42.66 / $51.29
| Facility | | $35.48 | $42.66 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $40.74 / $66.07
| Professional | | $30.90 | $40.74 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $33.88 / $51.29
| Professional | | $30.20 | $33.88 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $95.50 / $104.71
| Professional | | $74.13 | $95.50 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $51.29 / $64.57
| Professional | | $46.77 | $51.29 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $51.29 / $83.18
| Professional | | $22.91 | $51.29 | $83.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $77.62 / $107.15
| Professional | | $47.86 | $77.62 | $107.15 |