- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.18 / $18.22 / $22.08
| Facility | | $15.18 | $18.22 | $22.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.62 / $15.77 / $89.00
| Professional | | $15.62 | $15.77 | $89.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $22.08 / $22.08
| Professional | | $10.80 | $22.08 | $22.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.96 / $28.96 / $33.95
| Professional | | $21.96 | $28.96 | $33.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.39 / $22.08 / $27.60
| Professional | | $18.39 | $22.08 | $27.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.73 / $22.08 / $27.60
| Professional | | $7.73 | $22.08 | $27.60 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.82 / $24.88 / $34.93
| Professional | | $19.82 | $24.88 | $34.93 |