- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $85.11 / $102.33
| Facility | | $70.79 | $85.11 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $75.86 / $131.83
| Professional | | $63.10 | $75.86 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $67.61 / $102.33
| Professional | | $60.26 | $67.61 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $190.55 / $208.93
| Professional | | $147.91 | $190.55 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $102.33 / $128.82
| Professional | | $93.33 | $102.33 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $102.33 / $165.96
| Professional | | $37.15 | $102.33 | $165.96 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $147.91 / $213.80
| Professional | | $95.50 | $147.91 | $213.80 |