- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.35 / $7.13 / $67.34
| Facility | | $5.35 | $7.13 | $67.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.44 / $7.13 / $8.89
| Professional | | $5.44 | $7.13 | $8.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.09 / $5.09 / $5.09
| Professional | | $5.09 | $5.09 | $5.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.56 / $13.92 / $16.25
| Professional | | $10.56 | $13.92 | $16.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $7.78 / $9.72
| Professional | | $6.48 | $7.78 | $9.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $7.78 / $12.58
| Professional | | $2.72 | $7.78 | $12.58 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.51 / $11.78 / $16.30
| Professional | | $9.51 | $11.78 | $16.30 |