- 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 / $80.54
| Professional | | $34.31 | $44.30 | $80.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.90 / $79.48 / $79.48
| Professional | | $75.90 | $79.48 | $79.48 |
- 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
- $20.66 / $58.09 / $93.18
| Professional | | $20.66 | $58.09 | $93.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.05 / $62.12 / $71.62
| Professional | | $31.05 | $62.12 | $71.62 |