- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.92 / $4.70 / $39.61
| Facility | | $3.92 | $4.70 | $39.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.11 / $4.75 / $5.70
| Professional | | $4.11 | $4.75 | $5.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.73 / $3.73 / $3.73
| Professional | | $3.73 | $3.73 | $3.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.73 / $10.19 / $11.95
| Professional | | $7.73 | $10.19 | $11.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.75 / $5.70 / $7.13
| Professional | | $4.75 | $5.70 | $7.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.85 / $5.70 / $9.22
| Professional | | $2.85 | $5.70 | $9.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.97 / $8.19 / $9.44
| Professional | | $6.97 | $8.19 | $9.44 |