- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.61 / $20.95 / $89.93
| Facility | | $12.61 | $20.95 | $89.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.66 / $13.76 / $20.99
| Professional | | $13.66 | $13.76 | $20.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.17 / $18.35 / $18.35
| Professional | | $12.17 | $18.35 | $18.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.88 / $32.82 / $38.45
| Professional | | $24.88 | $32.82 | $38.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.29 / $18.35 / $22.94
| Professional | | $15.29 | $18.35 | $22.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.42 / $18.35 / $29.70
| Professional | | $6.42 | $18.35 | $29.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.12 / $27.79 / $38.47
| Professional | | $17.12 | $27.79 | $38.47 |