- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.43 / $12.36 / $88.54
| Facility | | $8.43 | $12.36 | $88.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.67 / $7.88 / $10.52
| Professional | | $6.67 | $7.88 | $10.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.07 / $10.82 / $10.82
| Professional | | $7.07 | $10.82 | $10.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.65 / $19.32 / $22.64
| Professional | | $14.65 | $19.32 | $22.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $10.82 / $13.53
| Professional | | $9.02 | $10.82 | $13.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.82 / $10.82 / $13.53
| Professional | | $10.82 | $10.82 | $13.53 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $16.25 / $22.68
| Professional | | $9.02 | $16.25 | $22.68 |