- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.79 / $94.14 / $94.14
| Facility | | $82.79 | $94.14 | $94.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.78 / $83.49 / $108.92
| Professional | | $66.78 | $83.49 | $108.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.58 / $96.58 / $96.58
| Professional | | $96.58 | $96.58 | $96.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.00 / $93.00 / $93.00
| Professional | | $93.00 | $93.00 | $93.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.98 / $117.79 / $137.41
| Professional | | $107.98 | $117.79 | $137.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.19 / $103.33 / $129.35
| Professional | | $100.19 | $103.33 | $129.35 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.45 / $69.94 / $83.49
| Professional | | $59.45 | $69.94 | $83.49 |