- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.99 / $28.84 / $34.67
| Facility | | $23.99 | $28.84 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $26.92 / $26.92
| Professional | | $20.89 | $26.92 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $22.91 / $34.67
| Professional | | $22.91 | $22.91 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $70.79 / $70.79
| Professional | | $50.12 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $34.67 / $43.65
| Professional | | $28.84 | $34.67 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $40.74 / $56.23
| Professional | | $12.02 | $40.74 | $56.23 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $52.48 / $72.44
| Professional | | $32.36 | $52.48 | $72.44 |