- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $40.74 / $50.12
| Facility | | $33.88 | $40.74 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $40.74 / $199.53
| Professional | | $40.74 | $40.74 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $23.44 / $24.55
| Professional | | $23.44 | $23.44 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $48.98 / $51.29
| Professional | | $41.69 | $48.98 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $50.12 / $61.66
| Professional | | $45.71 | $50.12 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $48.98 / $79.43
| Professional | | $30.90 | $48.98 | $79.43 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $64.57 / $93.33
| Professional | | $45.71 | $64.57 | $93.33 |