- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $23.99 / $32.36
| Professional | | $20.89 | $23.99 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Facility | | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $30.20 / $64.57
| Professional | | $24.55 | $30.20 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $33.88 / $39.81
| Professional | | $30.20 | $33.88 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $30.20 / $38.02
| Professional | | $25.12 | $30.20 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $29.51 / $45.71
| Professional | | $22.39 | $29.51 | $45.71 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $28.18 / $48.98
| Professional | | $21.88 | $28.18 | $48.98 |