- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.64 / $14.32 / $18.38
| Facility | | $12.64 | $14.32 | $18.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.79 / $13.79 / $94.22
| Professional | | $13.79 | $13.79 | $94.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.17 / $18.38 / $18.38
| Professional | | $12.17 | $18.38 | $18.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.93 / $32.88 / $38.45
| Professional | | $24.93 | $32.88 | $38.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.32 / $18.38 / $22.98
| Professional | | $15.32 | $18.38 | $22.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.38 / $18.38 / $22.98
| Professional | | $18.38 | $18.38 | $22.98 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.32 / $27.62 / $38.54
| Professional | | $15.32 | $27.62 | $38.54 |