- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.54 / $24.06 / $58.62
| Facility | | $16.54 | $24.06 | $58.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.91 / $23.42 / $28.44
| Professional | | $17.91 | $23.42 | $28.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.90 / $24.06 / $24.06
| Professional | | $15.90 | $24.06 | $24.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.61 / $40.83 / $47.58
| Professional | | $32.61 | $40.83 | $47.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.06 / $24.06 / $28.07
| Professional | | $22.06 | $24.06 | $28.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.06 / $28.02 / $38.93
| Professional | | $24.06 | $28.02 | $38.93 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.46 / $36.43 / $50.44
| Professional | | $22.46 | $36.43 | $50.44 |