- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $47.86 / $57.54
| Facility | | $39.81 | $47.86 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $40.74 / $60.26
| Professional | | $23.99 | $40.74 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $28.18 / $57.54
| Professional | | $25.12 | $28.18 | $57.54 |
- 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
- $52.48 / $57.54 / $72.44
| Professional | | $52.48 | $57.54 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $48.98 / $72.44
| Professional | | $16.98 | $48.98 | $72.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $64.57 / $91.20
| Professional | | $47.86 | $64.57 | $91.20 |