- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.62 / $51.62 / $51.62
| Facility | | $51.62 | $51.62 | $51.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.61 / $51.61 / $51.61
| Facility | | $51.61 | $51.61 | $51.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.68 / $28.68 / $28.68
| Professional | | $28.68 | $28.68 | $28.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.65 / $41.65 / $41.65
| Professional | | $41.65 | $41.65 | $41.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.55 / $34.42 / $40.15
| Professional | | $31.55 | $34.42 | $40.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.68 / $28.68 / $43.02
| Professional | | $28.68 | $28.68 | $43.02 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.01 / $32.51 / $36.79
| Professional | | $26.01 | $32.51 | $36.79 |