- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.86 / $10.63 / $55.08
| Facility | | $8.86 | $10.63 | $55.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.58 / $12.42 / $31.59
| Professional | | $9.58 | $12.42 | $31.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.89 / $12.89 / $18.82
| Professional | | $12.89 | $12.89 | $18.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.55 / $23.06 / $28.23
| Professional | | $18.55 | $23.06 | $28.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $12.89 / $16.11
| Professional | | $10.74 | $12.89 | $16.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.51 / $12.89 / $20.85
| Professional | | $4.51 | $12.89 | $20.85 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $19.36 / $27.02
| Professional | | $10.74 | $19.36 | $27.02 |