- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.97 / $5.97 / $7.24
| Facility | | $4.97 | $5.97 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.38 / $6.63 / $14.27
| Professional | | $5.38 | $6.63 | $14.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.71 / $7.24 / $7.24
| Professional | | $4.71 | $7.24 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.80 / $12.93 / $15.12
| Professional | | $9.80 | $12.93 | $15.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $7.24 / $9.05
| Professional | | $6.03 | $7.24 | $9.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $7.24 / $11.70
| Professional | | $2.52 | $7.24 | $11.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.75 / $10.96 / $15.17
| Professional | | $6.75 | $10.96 | $15.17 |