- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.84 / $34.67 / $41.69
| Facility | | $28.84 | $34.67 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $38.90 / $77.62
| Professional | | $23.99 | $38.90 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $28.18 / $41.69
| Professional | | $25.12 | $28.18 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $77.62 / $87.10
| Professional | | $60.26 | $77.62 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $41.69 / $52.48
| Professional | | $38.90 | $41.69 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $41.69 / $67.61
| Professional | | $16.98 | $41.69 | $67.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $60.26 / $89.13
| Professional | | $35.48 | $60.26 | $89.13 |