- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.89 / $14.27 / $70.64
| Facility | | $11.89 | $14.27 | $70.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.41 / $14.41 / $19.78
| Professional | | $14.41 | $14.41 | $19.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $17.29 / $17.29
| Professional | | $11.39 | $17.29 | $17.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.42 / $30.89 / $36.13
| Professional | | $23.42 | $30.89 | $36.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.41 / $17.29 / $21.62
| Professional | | $14.41 | $17.29 | $21.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.05 / $17.29 / $27.96
| Professional | | $6.05 | $17.29 | $27.96 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.14 / $26.16 / $36.22
| Professional | | $16.14 | $26.16 | $36.22 |