- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.43 / $11.32 / $68.98
| Facility | | $9.43 | $11.32 | $68.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.97 / $10.36 / $20.80
| Professional | | $9.97 | $10.36 | $20.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $13.72 / $13.72
| Professional | | $9.02 | $13.72 | $13.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.61 / $24.55 / $28.73
| Professional | | $18.61 | $24.55 | $28.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.43 / $13.72 / $16.00
| Professional | | $11.43 | $13.72 | $16.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.80 / $13.72 / $22.19
| Professional | | $4.80 | $13.72 | $22.19 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.80 / $20.77 / $28.76
| Professional | | $12.80 | $20.77 | $28.76 |