- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.51 / $21.02 / $80.80
| Facility | | $17.51 | $21.02 | $80.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.37 / $21.23 / $24.56
| Professional | | $18.37 | $21.23 | $24.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.88 / $25.48 / $25.48
| Professional | | $16.88 | $25.48 | $25.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.01 / $40.89 / $47.91
| Professional | | $31.01 | $40.89 | $47.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.23 / $25.48 / $31.85
| Professional | | $21.23 | $25.48 | $31.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.92 / $25.48 / $37.01
| Professional | | $8.92 | $25.48 | $37.01 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.78 / $34.65 / $47.97
| Professional | | $23.78 | $34.65 | $47.97 |