- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.16 / $120.16 / $120.16
| Facility | | $120.16 | $120.16 | $120.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.40 / $61.81 / $55,018.98
| Professional | | $59.40 | $61.81 | $55,018.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.16 / $120.16 / $120.16
| Facility | | $120.16 | $120.16 | $120.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.41 / $59.41 / $59.41
| Professional | | $59.41 | $59.41 | $59.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.80 / $85.80 / $85.80
| Professional | | $85.80 | $85.80 | $85.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.36 / $71.30 / $83.18
| Professional | | $65.36 | $71.30 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.41 / $70.52 / $89.12
| Professional | | $59.41 | $70.52 | $89.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.70 / $68.50 / $75.81
| Professional | | $50.70 | $68.50 | $75.81 |