- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.12 / $23.29 / $28.29
| Professional | | $12.12 | $23.29 | $28.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.01 / $27.01 / $31.44
| Facility | | $27.01 | $27.01 | $31.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.39 / $27.97 / $43.53
| Professional | | $21.39 | $27.97 | $43.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.57 / $41.43 / $41.43
| Professional | | $39.57 | $41.43 | $41.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.70 / $39.57 / $55.40
| Professional | | $27.70 | $39.57 | $55.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.45 / $24.65 / $43.53
| Professional | | $13.45 | $24.65 | $43.53 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.75 / $34.65 / $39.57
| Professional | | $29.75 | $34.65 | $39.57 |