- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.13 / $6.02 / $88.61
| Facility | | $4.13 | $6.02 | $88.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.37 / $5.52 / $25.00
| Professional | | $4.37 | $5.52 | $25.00 |
- 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
- $8.15 / $10.76 / $12.63
| Professional | | $8.15 | $10.76 | $12.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $6.02 / $7.53
| Professional | | $5.01 | $6.02 | $7.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $6.02 / $9.73
| Professional | | $2.11 | $6.02 | $9.73 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.63 / $9.41 / $12.64
| Professional | | $7.63 | $9.41 | $12.64 |