- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.51 / $11.41 / $90.57
| Facility | | $9.51 | $11.41 | $90.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.66 / $10.13 / $20.62
| Professional | | $9.66 | $10.13 | $20.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.84 / $13.84 / $13.84
| Professional | | $13.84 | $13.84 | $13.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.71 / $22.49 / $27.36
| Professional | | $17.71 | $22.49 | $27.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.53 / $13.84 / $17.30
| Professional | | $11.53 | $13.84 | $17.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.84 / $13.84 / $17.30
| Professional | | $4.84 | $13.84 | $17.30 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.80 / $15.57 / $25.94
| Professional | | $9.80 | $15.57 | $25.94 |