- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.34 / $10.68 / $152.29
| Facility | | $7.34 | $10.68 | $152.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.75 / $8.06 / $10.39
| Professional | | $7.75 | $8.06 | $10.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.07 / $10.68 / $10.68
| Professional | | $7.07 | $10.68 | $10.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.46 / $19.09 / $22.32
| Professional | | $14.46 | $19.09 | $22.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.90 / $10.68 / $12.46
| Professional | | $8.90 | $10.68 | $12.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.74 / $10.68 / $17.27
| Professional | | $3.74 | $10.68 | $17.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.97 / $16.16 / $22.37
| Professional | | $9.97 | $16.16 | $22.37 |