- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.68 / $5.61 / $41.19
| Facility | | $4.68 | $5.61 | $41.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.76 / $4.96 / $15.28
| Professional | | $4.76 | $4.96 | $15.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.51 / $6.80 / $6.80
| Professional | | $4.51 | $6.80 | $6.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.23 / $12.18 / $14.27
| Professional | | $9.23 | $12.18 | $14.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.67 / $6.80 / $8.51
| Professional | | $5.67 | $6.80 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.38 / $6.80 / $11.02
| Professional | | $2.38 | $6.80 | $11.02 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.35 / $10.31 / $14.27
| Professional | | $6.35 | $10.31 | $14.27 |