- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.24 / $3.89 / $63.90
| Facility | | $3.24 | $3.89 | $63.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.53 / $4.58 / $27.00
| Professional | | $4.53 | $4.58 | $27.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.14 / $4.72 / $4.72
| Professional | | $3.14 | $4.72 | $4.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.36 / $8.40 / $9.84
| Professional | | $6.36 | $8.40 | $9.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.93 / $4.72 / $5.90
| Professional | | $3.93 | $4.72 | $5.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.36 / $4.72 / $7.62
| Professional | | $2.36 | $4.72 | $7.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.40 / $7.07 / $9.86
| Professional | | $4.40 | $7.07 | $9.86 |