- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.76 / $57.43 / $78.23
| Facility | | $4.76 | $57.43 | $78.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $5.22 / $6.94
| Professional | | $4.47 | $5.22 | $6.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.51 / $4.51 / $4.51
| Professional | | $4.51 | $4.51 | $4.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $12.43 / $14.53
| Professional | | $9.42 | $12.43 | $14.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.78 / $6.94 / $8.67
| Professional | | $5.78 | $6.94 | $8.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.43 / $6.94 / $11.21
| Professional | | $2.43 | $6.94 | $11.21 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.49 / $10.52 / $14.56
| Professional | | $8.49 | $10.52 | $14.56 |