- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.45 / $39.04 / $50.11
| Facility | | $34.45 | $39.04 | $50.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.29 / $32.29 / $32.29
| Professional | | $32.29 | $32.29 | $32.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.18 / $50.11 / $50.11
| Professional | | $33.18 | $50.11 | $50.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.90 / $85.02 / $99.08
| Professional | | $67.90 | $85.02 | $99.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.94 / $50.11 / $58.46
| Professional | | $45.94 | $50.11 | $58.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.11 / $58.33 / $81.05
| Professional | | $50.11 | $58.33 | $81.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $75.25 / $104.99
| Professional | | $46.77 | $75.25 | $104.99 |