- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.79 / $5.07 / $38.82
| Facility | | $4.79 | $5.07 | $38.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.55 / $4.79 / $6.14
| Professional | | $4.55 | $4.79 | $6.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $4.12 / $4.12
| Professional | | $4.12 | $4.12 | $4.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.34 / $11.01 / $12.87
| Professional | | $8.34 | $11.01 | $12.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.12 / $6.14 / $7.68
| Professional | | $5.12 | $6.14 | $7.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.15 / $6.14 / $9.94
| Professional | | $2.15 | $6.14 | $9.94 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.52 / $8.84 / $10.18
| Professional | | $7.52 | $8.84 | $10.18 |