- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.39 / $38.97 / $50.02
| Facility | | $34.39 | $38.97 | $50.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.59 / $57.23 / $131.00
| Professional | | $40.59 | $57.23 | $131.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.88 / $50.02 / $50.02
| Professional | | $27.88 | $50.02 | $50.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.06 / $71.45 / $83.26
| Professional | | $57.06 | $71.45 | $83.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.85 / $50.02 / $58.35
| Professional | | $45.85 | $50.02 | $58.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.04 / $50.02 / $68.12
| Professional | | $49.04 | $50.02 | $68.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.68 / $63.26 / $90.72
| Professional | | $41.68 | $63.26 | $90.72 |