- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.94 / $8.64 / $63.02
| Facility | | $5.94 | $8.64 | $63.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.33 / $7.20 / $16.32
| Professional | | $5.33 | $7.20 | $16.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.69 / $5.69 / $5.69
| Professional | | $5.69 | $5.69 | $5.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.68 / $15.41 / $18.11
| Professional | | $11.68 | $15.41 | $18.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.20 / $8.64 / $10.80
| Professional | | $7.20 | $8.64 | $10.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $8.64 / $13.98
| Professional | | $3.02 | $8.64 | $13.98 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.56 / $13.08 / $18.11
| Professional | | $10.56 | $13.08 | $18.11 |