- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.77 / $16.73 / $21.48
| Facility | | $14.77 | $16.73 | $21.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.71 / $24.58 / $124.00
| Professional | | $20.71 | $24.58 | $124.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $21.48 / $21.48
| Professional | | $14.13 | $21.48 | $21.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.12 / $38.40 / $44.97
| Professional | | $29.12 | $38.40 | $44.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.89 / $21.48 / $26.85
| Professional | | $17.89 | $21.48 | $26.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.52 / $21.48 / $34.76
| Professional | | $7.52 | $21.48 | $34.76 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.05 / $32.53 / $45.04
| Professional | | $20.05 | $32.53 | $45.04 |