- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.85 / $35.93 / $48.78
| Professional | | $34.85 | $35.93 | $48.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.45 / $77.45 / $77.45
| Facility | | $77.45 | $77.45 | $77.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.31 / $44.30 / $78.78
| Professional | | $34.31 | $44.30 | $78.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.45 / $81.09 / $81.09
| Professional | | $77.45 | $81.09 | $81.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.13 / $71.62 / $100.27
| Professional | | $50.13 | $71.62 | $100.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.39 / $42.75 / $78.78
| Professional | | $21.39 | $42.75 | $78.78 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.05 / $62.12 / $71.62
| Professional | | $31.05 | $62.12 | $71.62 |