- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.36 / $46.42 / $50.07
| Professional | | $35.36 | $46.42 | $50.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.64 / $29.64 / $29.64
| Facility | | $29.64 | $29.64 | $29.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.16 / $36.96 / $78.50
| Professional | | $24.16 | $36.96 | $78.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.04 / $44.91 / $53.61
| Professional | | $40.04 | $44.91 | $53.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.64 / $29.06 / $33.90
| Professional | | $26.64 | $29.06 | $33.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.54 / $33.14 / $55.17
| Professional | | $24.54 | $33.14 | $55.17 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.52 / $33.64 / $95.92
| Professional | | $22.52 | $33.64 | $95.92 |