- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.99 / $11.32 / $14.53
| Facility | | $9.99 | $11.32 | $14.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.82 / $9.44 / $14.48
| Professional | | $7.82 | $9.44 | $14.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.56 / $14.53 / $27.03
| Professional | | $7.56 | $14.53 | $27.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.60 / $21.88 / $25.98
| Professional | | $18.60 | $21.88 | $25.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.11 / $14.53 / $16.95
| Professional | | $12.11 | $14.53 | $16.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.09 / $7.27 / $16.92
| Professional | | $5.09 | $7.27 | $16.92 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.56 / $22.00 / $30.46
| Professional | | $13.56 | $22.00 | $30.46 |