- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.03 / $112.56 / $157.13
| Facility | | $7.03 | $112.56 | $157.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.70 / $8.68 / $23.17
| Professional | | $6.70 | $8.68 | $23.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.89 / $5.89 / $5.89
| Professional | | $5.89 | $5.89 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.20 / $16.10 / $18.84
| Professional | | $12.20 | $16.10 | $18.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.52 / $9.02 / $11.28
| Professional | | $7.52 | $9.02 | $11.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.16 / $9.02 / $14.59
| Professional | | $3.16 | $9.02 | $14.59 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.01 / $12.98 / $14.92
| Professional | | $11.01 | $12.98 | $14.92 |