- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $75.86 / $75.86
| Facility | | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.67 / $43.67 / $57.65
| Professional | | $43.67 | $43.67 | $57.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.98 / $41.98 / $41.98
| Professional | | $41.98 | $41.98 | $41.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.27 / $60.27 / $60.27
| Professional | | $60.27 | $60.27 | $60.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.18 / $50.38 / $58.77
| Professional | | $46.18 | $50.38 | $58.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.98 / $49.53 / $62.97
| Professional | | $41.98 | $49.53 | $62.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $48.09 / $53.25
| Professional | | $36.31 | $48.09 | $53.25 |