- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.08 / $4.90 / $89.65
| Facility | | $4.08 | $4.90 | $89.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.62 / $4.48 / $6.79
| Professional | | $2.62 | $4.48 | $6.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.93 / $3.93 / $3.93
| Professional | | $3.93 | $3.93 | $3.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.06 / $10.63 / $12.42
| Professional | | $8.06 | $10.63 | $12.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.95 / $5.94 / $7.43
| Professional | | $4.95 | $5.94 | $7.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.08 / $5.94 / $9.60
| Professional | | $2.08 | $5.94 | $9.60 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.54 / $9.27 / $12.46
| Professional | | $7.54 | $9.27 | $12.46 |