- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.84 / $29.54 / $74.09
| Facility | | $4.84 | $29.54 | $74.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.89 / $4.69 / $6.22
| Professional | | $3.89 | $4.69 | $6.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $6.22 / $6.22
| Professional | | $4.12 | $6.22 | $6.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.43 / $11.13 / $13.02
| Professional | | $8.43 | $11.13 | $13.02 |
- 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
- $6.22 / $6.22 / $7.77
| Professional | | $6.22 | $6.22 | $7.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.18 / $9.40 / $13.01
| Professional | | $5.18 | $9.40 | $13.01 |