- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.65 / $7.25 / $61.47
| Facility | | $5.65 | $7.25 | $61.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.46 / $5.46 / $7.05
| Professional | | $4.46 | $5.46 | $7.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.71 / $7.25 / $7.25
| Professional | | $4.71 | $7.25 | $7.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.80 / $12.93 / $15.20
| Professional | | $9.80 | $12.93 | $15.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.04 / $7.25 / $9.06
| Professional | | $6.04 | $7.25 | $9.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $7.25 / $11.71
| Professional | | $2.54 | $7.25 | $11.71 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $10.97 / $15.19
| Professional | | $6.76 | $10.97 | $15.19 |