- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.47 / $24.33 / $29.81
| Facility | | $21.47 | $24.33 | $29.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.09 / $32.95 / $37.83
| Professional | | $14.09 | $32.95 | $37.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.99 / $29.81 / $31.58
| Professional | | $9.99 | $29.81 | $31.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.05 / $57.05 / $61.24
| Professional | | $57.05 | $57.05 | $61.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.38 / $26.24 / $33.39
| Professional | | $22.38 | $26.24 | $33.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.81 / $38.19 / $95.00
| Professional | | $29.81 | $38.19 | $95.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.80 / $32.13 / $57.06
| Professional | | $20.80 | $32.13 | $57.06 |