- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.15 / $39.99 / $56.57
| Professional | | $36.15 | $39.99 | $56.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.38 / $41.38 / $41.38
| Facility | | $41.38 | $41.38 | $41.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.81 / $46.36 / $61.58
| Professional | | $41.81 | $46.36 | $61.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.67 / $58.16 / $69.43
| Professional | | $50.67 | $58.16 | $69.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.96 / $43.60 / $50.86
| Professional | | $39.96 | $43.60 | $50.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.44 / $49.27 / $60.23
| Professional | | $36.44 | $49.27 | $60.23 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.89 / $34.09 / $46.53
| Professional | | $26.89 | $34.09 | $46.53 |