- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $14.79 / $20.42
| Facility | | $12.30 | $14.79 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $14.13 / $331.13
| Professional | | $10.96 | $14.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $17.78
| Professional | | $12.02 | $12.02 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $33.11 / $37.15
| Professional | | $25.70 | $33.11 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $17.78 / $22.39
| Professional | | $15.14 | $17.78 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $20.89 / $28.84
| Professional | | $6.31 | $20.89 | $28.84 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $26.92 / $38.02
| Professional | | $16.98 | $26.92 | $38.02 |