- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $12.59 / $97.72
| Facility | | $10.47 | $12.59 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $11.48 / $15.14
| Professional | | $8.91 | $11.48 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $10.23 / $15.14
| Professional | | $10.23 | $10.23 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $28.18 / $31.62
| Professional | | $21.88 | $28.18 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $15.14 / $23.44
| Professional | | $12.88 | $15.14 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.37 / $17.78 / $24.55
| Professional | | $5.37 | $17.78 | $24.55 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $21.88 / $32.36
| Professional | | $12.88 | $21.88 | $32.36 |