- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.89 / $21.48 / $76.05
| Facility | | $17.89 | $21.48 | $76.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.88 / $19.30 / $19.67
| Professional | | $18.88 | $19.30 | $19.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.28 / $26.04 / $26.04
| Professional | | $17.28 | $26.04 | $26.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.24 / $46.49 / $54.43
| Professional | | $35.24 | $46.49 | $54.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.70 / $26.04 / $32.54
| Professional | | $21.70 | $26.04 | $32.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.11 / $26.04 / $42.12
| Professional | | $9.11 | $26.04 | $42.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.30 / $39.39 / $54.54
| Professional | | $24.30 | $39.39 | $54.54 |