- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.07 / $28.05 / $59.50
| Facility | | $3.07 | $28.05 | $59.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $3.61 / $16.05
| Professional | | $2.72 | $3.61 | $16.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.77 / $3.94 / $3.94
| Professional | | $1.77 | $3.94 | $3.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.09 / $3.85 / $4.55
| Professional | | $3.09 | $3.85 | $4.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.28 / $3.94 / $4.92
| Professional | | $3.28 | $3.94 | $4.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.97 / $3.94 / $4.92
| Professional | | $1.97 | $3.94 | $4.92 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.78 / $3.97 / $6.29
| Professional | | $2.78 | $3.97 | $6.29 |