- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.12 / $37.40 / $74.80
| Facility | | $5.12 | $37.40 | $74.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.57 / $2.57 / $2.57
| Facility | | $2.57 | $2.57 | $2.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.90 / $2.90 / $2.90
| Professional | | $2.90 | $2.90 | $2.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.21 / $1.21 / $1.21
| Professional | | $1.21 | $1.21 | $1.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.19 / $3.48 / $4.05
| Professional | | $3.19 | $3.48 | $4.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.99 / $2.90 / $4.34
| Professional | | $0.99 | $2.90 | $4.34 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $1.39 / $2.31
| Professional | | $1.07 | $1.39 | $2.31 |