- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.08 / $56.08 / $56.08
| Facility | | $56.08 | $56.08 | $56.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.07 / $56.07 / $56.07
| Facility | | $56.07 | $56.07 | $56.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.61 / $23.61 / $23.61
| Professional | | $23.61 | $23.61 | $23.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.32 / $37.32 / $37.32
| Professional | | $37.32 | $37.32 | $37.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.97 / $28.33 / $33.04
| Professional | | $25.97 | $28.33 | $33.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.61 / $30.68 / $35.42
| Professional | | $23.61 | $30.68 | $35.42 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.80 / $30.00 / $38.97
| Professional | | $6.80 | $30.00 | $38.97 |