- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.13 / $4.97 / $28.05
| Facility | | $4.13 | $4.97 | $28.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.80 / $6.89 / $21.70
| Professional | | $5.80 | $6.89 | $21.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.93 / $6.02 / $6.02
| Professional | | $3.93 | $6.02 | $6.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.55 / $8.31 / $10.11
| Professional | | $6.55 | $8.31 | $10.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $6.02 / $7.53
| Professional | | $5.01 | $6.02 | $7.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.01 / $6.02 / $9.73
| Professional | | $3.01 | $6.02 | $9.73 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.26 / $9.23 / $12.94
| Professional | | $4.26 | $9.23 | $12.94 |