- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.32 / $244.32 / $430.41
| Facility | | $244.32 | $244.32 | $430.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.12 / $3.19 / $175.43
| Professional | | $3.12 | $3.19 | $175.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.35 / $7.35 / $7.35
| Facility | | $7.35 | $7.35 | $7.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $3.13 / $4.04
| Professional | | $3.13 | $3.13 | $4.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.57 / $3.57 / $3.57
| Professional | | $3.57 | $3.57 | $3.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.13 / $3.75 / $4.69
| Professional | | $3.13 | $3.75 | $4.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.97 / $3.32 / $4.70
| Professional | | $2.97 | $3.32 | $4.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.79 / $4.38 / $61.43
| Professional | | $2.79 | $4.38 | $61.43 |