- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $41.69 / $50.12
| Facility | | $34.67 | $41.69 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $38.90 / $64.57
| Professional | | $30.90 | $38.90 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $33.11 / $50.12
| Professional | | $29.51 | $33.11 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $93.33 / $102.33
| Professional | | $72.44 | $93.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $50.12 / $63.10
| Professional | | $45.71 | $50.12 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $50.12 / $81.28
| Professional | | $22.91 | $50.12 | $81.28 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $75.86 / $104.71
| Professional | | $46.77 | $75.86 | $104.71 |