- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.01 / $6.61 / $53.70
| Facility | | $5.01 | $6.61 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.25 / $6.03
| Professional | | $3.98 | $5.25 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.68 / $4.68 / $7.24
| Professional | | $4.68 | $4.68 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $13.49 / $14.79
| Professional | | $10.47 | $13.49 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $7.24 / $10.23
| Professional | | $6.03 | $7.24 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.51 / $8.51 / $11.75
| Professional | | $2.51 | $8.51 | $11.75 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $10.96 / $15.14
| Professional | | $6.76 | $10.96 | $15.14 |