- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.71 / $11.65 / $39.11
| Facility | | $9.71 | $11.65 | $39.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.25 / $14.12 / $22.75
| Professional | | $10.25 | $14.12 | $22.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $14.12 / $14.12
| Professional | | $9.42 | $14.12 | $14.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.13 / $25.23 / $29.52
| Professional | | $19.13 | $25.23 | $29.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.77 / $14.12 / $16.48
| Professional | | $11.77 | $14.12 | $16.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.12 / $14.12 / $22.86
| Professional | | $14.12 | $14.12 | $22.86 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.77 / $21.21 / $29.59
| Professional | | $11.77 | $21.21 | $29.59 |