- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.31 / $13.57 / $94.82
| Facility | | $11.31 | $13.57 | $94.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.86 / $16.41 / $18.82
| Professional | | $15.86 | $16.41 | $18.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $16.45 / $16.45
| Professional | | $10.80 | $16.45 | $16.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.28 / $29.40 / $34.39
| Professional | | $22.28 | $29.40 | $34.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.71 / $16.45 / $20.57
| Professional | | $13.71 | $16.45 | $20.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.76 / $16.45 / $26.60
| Professional | | $5.76 | $16.45 | $26.60 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.65 / $20.14 / $30.85
| Professional | | $11.65 | $20.14 | $30.85 |