- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.77 / $94.45 / $414.41
| Facility | | $11.77 | $94.45 | $414.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.55 / $12.73 / $19.59
| Professional | | $10.55 | $12.73 | $19.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $11.39 / $11.39
| Professional | | $11.39 | $11.39 | $11.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.23 / $30.65 / $35.79
| Professional | | $23.23 | $30.65 | $35.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.27 / $17.12 / $21.41
| Professional | | $14.27 | $17.12 | $21.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.99 / $17.12 / $27.70
| Professional | | $5.99 | $17.12 | $27.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.94 / $26.29 / $35.89
| Professional | | $20.94 | $26.29 | $35.89 |