- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.80 / $4.30 / $4.55
| Facility | | $3.80 | $4.30 | $4.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.37 / $5.37 / $5.37
| Professional | | $5.37 | $5.37 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.73 / $3.73 / $3.73
| Professional | | $3.73 | $3.73 | $3.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.49 / $9.89 / $11.56
| Professional | | $7.49 | $9.89 | $11.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.59 / $5.52 / $6.90
| Professional | | $4.59 | $5.52 | $6.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.93 / $5.52 / $8.92
| Professional | | $1.93 | $5.52 | $8.92 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.99 / $8.60 / $11.56
| Professional | | $6.99 | $8.60 | $11.56 |