- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.77 / $179.68 / $179.68
| Facility | | $14.77 | $179.68 | $179.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $7.64 / $10.09
| Professional | | $7.41 | $7.64 | $10.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.16 / $13.16 / $13.16
| Facility | | $13.16 | $13.16 | $13.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.35 / $7.35 / $7.35
| Professional | | $7.35 | $7.35 | $7.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.48 / $12.48 / $12.48
| Professional | | $12.48 | $12.48 | $12.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.08 / $8.82 / $10.29
| Professional | | $8.08 | $8.82 | $10.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.35 / $10.26 / $11.03
| Professional | | $7.35 | $10.26 | $11.03 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.17 / $6.62 / $11.30
| Professional | | $2.17 | $6.62 | $11.30 |