- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.03 / $14.77 / $18.10
| Facility | | $13.03 | $14.77 | $18.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.26 / $15.88 / $22.44
| Professional | | $12.26 | $15.88 | $22.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.96 / $18.10 / $20.75
| Professional | | $14.96 | $18.10 | $20.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.41 / $21.24 / $24.80
| Professional | | $18.41 | $21.24 | $24.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.66 / $16.11 / $20.27
| Professional | | $12.66 | $16.11 | $20.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,078.00 / $1,078.00
| Facility | | $1,078.00 | $1,078.00 | $1,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.77 / $18.98 / $24.80
| Professional | | $14.77 | $18.98 | $24.80 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $14.28 / $19.94
| Professional | | $2.50 | $14.28 | $19.94 |