- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.52 / $3.66 / $34.92
| Facility | | $2.52 | $3.66 | $34.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $3.05 / $3.66
| Professional | | $2.72 | $3.05 | $3.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.36 / $3.66 / $3.66
| Professional | | $2.36 | $3.66 | $3.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.95 / $6.53 / $7.60
| Professional | | $4.95 | $6.53 | $7.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.05 / $3.66 / $4.58
| Professional | | $3.05 | $3.66 | $4.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.83 / $3.66 / $5.91
| Professional | | $1.83 | $3.66 | $5.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.42 / $5.51 / $7.63
| Professional | | $3.42 | $5.51 | $7.63 |