- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.77 / $12.92 / $94.58
| Facility | | $10.77 | $12.92 | $94.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.78 / $11.83 / $15.09
| Professional | | $9.78 | $11.83 | $15.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $15.66 / $15.66
| Professional | | $10.40 | $15.66 | $15.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.20 / $27.97 / $32.75
| Professional | | $21.20 | $27.97 | $32.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.05 / $15.66 / $18.27
| Professional | | $13.05 | $15.66 | $18.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.48 / $15.66 / $25.32
| Professional | | $5.48 | $15.66 | $25.32 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.62 / $23.70 / $32.81
| Professional | | $14.62 | $23.70 | $32.81 |