- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.34 / $7.76 / $90.95
| Facility | | $5.34 | $7.76 | $90.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.78 / $5.77 / $9.17
| Professional | | $4.78 | $5.77 | $9.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.09 / $7.76 / $7.76
| Professional | | $5.09 | $7.76 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.56 / $13.92 / $16.25
| Professional | | $10.56 | $13.92 | $16.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.47 / $7.76 / $9.06
| Professional | | $6.47 | $7.76 | $9.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $7.76 / $12.57
| Professional | | $2.72 | $7.76 | $12.57 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.47 / $11.67 / $16.29
| Professional | | $6.47 | $11.67 | $16.29 |