- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.11 / $18.11 / $25.87
| Facility | | $18.11 | $18.11 | $25.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $13.76 / $18.92
| Professional | | $10.00 | $13.76 | $18.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.11 / $18.11 / $26.99
| Facility | | $18.11 | $18.11 | $26.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.57 / $16.76 / $71.53
| Professional | | $12.57 | $16.76 | $71.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.83 / $18.95 / $23.74
| Professional | | $14.83 | $18.95 | $23.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $14.17 / $15.40
| Professional | | $13.55 | $14.17 | $15.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.89 / $12.63 / $20.05
| Professional | | $9.89 | $12.63 | $20.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.92 / $15.87 / $250.00
| Professional | | $10.92 | $15.87 | $250.00 |