- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.33 / $47.97 / $61.57
| Facility | | $42.33 | $47.97 | $61.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.07 / $52.07 / $70.45
| Professional | | $52.07 | $52.07 | $70.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.54 / $61.57 / $61.57
| Professional | | $34.54 | $61.57 | $61.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.15 / $100.36 / $116.95
| Professional | | $80.15 | $100.36 | $116.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.44 / $61.57 / $71.83
| Professional | | $56.44 | $61.57 | $71.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.57 / $63.35 / $76.97
| Professional | | $61.57 | $63.35 | $76.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.61 / $69.27 / $115.45
| Professional | | $43.61 | $69.27 | $115.45 |