- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.43 / $22.12 / $73.44
| Facility | | $18.43 | $22.12 | $73.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.57 / $25.84 / $30.67
| Professional | | $24.57 | $25.84 | $30.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.81 / $26.81 / $27.85
| Professional | | $26.81 | $26.81 | $27.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.84 / $43.13 / $56.07
| Professional | | $23.84 | $43.13 | $56.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.34 / $26.81 / $33.51
| Professional | | $22.34 | $26.81 | $33.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.38 / $26.81 / $43.38
| Professional | | $9.38 | $26.81 | $43.38 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.02 / $40.57 / $56.18
| Professional | | $25.02 | $40.57 | $56.18 |