- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.03 / $8.03 / $104.52
| Facility | | $8.03 | $8.03 | $104.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.22 / $58.87 / $291.70
| Professional | | $3.22 | $58.87 | $291.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.03 / $8.03 / $8.03
| Facility | | $8.03 | $8.03 | $8.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.22 / $3.22 / $3.22
| Professional | | $3.22 | $3.22 | $3.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.07 / $6.07 / $6.07
| Professional | | $6.07 | $6.07 | $6.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.54 / $3.86 / $4.51
| Professional | | $3.54 | $3.86 | $4.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $4.83 / $4.99
| Professional | | $4.47 | $4.83 | $4.99 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $3.95 / $5.41
| Professional | | $2.52 | $3.95 | $5.41 |