- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.21 / $9.61 / $128.09
| Facility | | $7.21 | $9.61 | $128.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.47 / $7.63 / $9.61
| Professional | | $6.47 | $7.63 | $9.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.87 / $10.49 / $10.49
| Professional | | $6.87 | $10.49 | $10.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.23 / $18.77 / $21.95
| Professional | | $14.23 | $18.77 | $21.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.74 / $10.49 / $13.11
| Professional | | $8.74 | $10.49 | $13.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.67 / $10.49 / $16.97
| Professional | | $3.67 | $10.49 | $16.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.74 / $15.75 / $21.98
| Professional | | $8.74 | $15.75 | $21.98 |