- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.23 / $45.16 / $73.72
| Facility | | $4.23 | $45.16 | $73.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $3.94 / $5.42
| Professional | | $3.39 | $3.94 | $5.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.53 / $3.53 / $3.53
| Professional | | $3.53 | $3.53 | $3.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.35 / $9.69 / $11.36
| Professional | | $7.35 | $9.69 | $11.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.51 / $5.42 / $6.78
| Professional | | $4.51 | $5.42 | $6.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.90 / $5.42 / $8.77
| Professional | | $1.90 | $5.42 | $8.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.63 / $8.19 / $11.36
| Professional | | $6.63 | $8.19 | $11.36 |