- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.58 / $11.49 / $151.69
| Facility | | $9.58 | $11.49 | $151.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.11 / $10.11 / $15.94
| Professional | | $10.11 | $10.11 | $15.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.23 / $13.93 / $13.93
| Professional | | $9.23 | $13.93 | $13.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.85 / $24.86 / $29.15
| Professional | | $18.85 | $24.86 | $29.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.61 / $13.93 / $17.42
| Professional | | $11.61 | $13.93 | $17.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.88 / $13.93 / $22.53
| Professional | | $4.88 | $13.93 | $22.53 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $21.06 / $29.16
| Professional | | $13.00 | $21.06 | $29.16 |