- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.81 / $49.81 / $49.81
| Facility | | $49.81 | $49.81 | $49.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.63 / $46.31 / $67.09
| Professional | | $38.63 | $46.31 | $67.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.99 / $63.86 / $79.34
| Professional | | $60.99 | $63.86 | $79.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.57 / $54.73 / $85.13
| Professional | | $42.57 | $54.73 | $85.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.66 / $49.04 / $67.09
| Professional | | $27.66 | $49.04 | $67.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.64 / $50.27 / $60.99
| Professional | | $49.64 | $50.27 | $60.99 |