- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.76 / $86.99 / $102.34
| Facility | | $76.76 | $86.99 | $102.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.74 / $47.74 / $47.74
| Professional | | $47.74 | $47.74 | $47.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.12 / $49.12 / $149.81
| Professional | | $49.12 | $49.12 | $149.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.74 / $92.20 / $104.86
| Professional | | $11.74 | $92.20 | $104.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.39 / $90.97 / $94.76
| Professional | | $83.39 | $90.97 | $94.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.67 / $102.34 / $120.74
| Professional | | $89.67 | $102.34 | $120.74 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.03 / $111.68 / $205.96
| Professional | | $69.03 | $111.68 | $205.96 |