- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.90 / $5.89 / $7.24
| Facility | | $4.90 | $5.89 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $3.98 / $5.01
| Professional | | $2.00 | $3.98 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.95 / $2.95 / $2.95
| Professional | | $2.95 | $2.95 | $2.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $8.32 / $9.33
| Professional | | $6.46 | $8.32 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $7.24 / $8.91
| Professional | | $6.03 | $7.24 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $5.25 / $8.91
| Professional | | $3.63 | $5.25 | $8.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $5.75 / $7.08
| Professional | | $5.50 | $5.75 | $7.08 |