- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.70 / $4.44 / $55.39
| Facility | | $3.70 | $4.44 | $55.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.93 / $5.34 / $11.21
| Professional | | $4.93 | $5.34 | $11.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.53 / $5.38 / $5.38
| Professional | | $3.53 | $5.38 | $5.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.25 / $9.57 / $11.23
| Professional | | $7.25 | $9.57 | $11.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.48 / $5.38 / $6.72
| Professional | | $4.48 | $5.38 | $6.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.88 / $5.38 / $8.69
| Professional | | $1.88 | $5.38 | $8.69 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $8.13 / $11.25
| Professional | | $5.01 | $8.13 | $11.25 |