- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.26 / $43.12 / $64.61
| Facility | | $4.26 | $43.12 | $64.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.69 / $5.70 / $6.22
| Professional | | $4.69 | $5.70 | $6.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $4.12 / $4.12
| Professional | | $4.12 | $4.12 | $4.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.39 / $11.06 / $12.92
| Professional | | $8.39 | $11.06 | $12.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.18 / $6.22 / $7.77
| Professional | | $5.18 | $6.22 | $7.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.18 / $6.22 / $10.05
| Professional | | $2.18 | $6.22 | $10.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.58 / $8.93 / $10.26
| Professional | | $7.58 | $8.93 | $10.26 |