- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.26 / $4.82 / $6.19
| Facility | | $4.26 | $4.82 | $6.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.74 / $5.16 / $6.16
| Professional | | $2.74 | $5.16 | $6.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $4.12 / $4.12
| Professional | | $4.12 | $4.12 | $4.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.39 / $11.06 / $12.92
| Professional | | $8.39 | $11.06 | $12.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.16 / $6.19 / $7.74
| Professional | | $5.16 | $6.19 | $7.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.17 / $6.19 / $10.02
| Professional | | $2.17 | $6.19 | $10.02 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.56 / $8.90 / $10.23
| Professional | | $7.56 | $8.90 | $10.23 |