- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.84 / $7.10 / $56.19
| Facility | | $4.84 | $7.10 | $56.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.48 / $4.68 / $6.22
| Professional | | $4.48 | $4.68 | $6.22 |
- 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
- $8.43 / $11.13 / $13.02
| Professional | | $8.43 | $11.13 | $13.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.18 / $6.22 / $7.77
| Professional | | $5.18 | $6.22 | $7.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.18 / $6.22 / $10.05
| Professional | | $2.18 | $6.22 | $10.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.18 / $7.95 / $10.28
| Professional | | $5.18 | $7.95 | $10.28 |