- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.60 / $64.14 / $82.32
| Facility | | $56.60 | $64.14 | $82.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.08 / $53.08 / $53.08
| Professional | | $53.08 | $53.08 | $53.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.38 / $82.32 / $82.32
| Professional | | $54.38 | $82.32 | $82.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.51 / $72.78 / $80.95
| Professional | | $65.51 | $72.78 | $80.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.45 / $82.32 / $96.04
| Professional | | $75.45 | $82.32 | $96.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.84 / $82.32 / $123.98
| Professional | | $65.84 | $82.32 | $123.98 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.76 / $72.06 / $113.19
| Professional | | $49.76 | $72.06 | $113.19 |