- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.26 / $5.13 / $108.57
| Facility | | $4.26 | $5.13 | $108.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.51 / $5.98 / $13.29
| Professional | | $4.51 | $5.98 | $13.29 |
- 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
- $8.43 / $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
- $3.11 / $6.22 / $10.05
| Professional | | $3.11 | $6.22 | $10.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $8.94 / $10.28
| Professional | | $7.59 | $8.94 | $10.28 |