- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.74 / $5.38 / $6.90
| Facility | | $4.74 | $5.38 | $6.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $4.47 / $7.89
| Professional | | $4.47 | $4.47 | $7.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.93 / $6.90 / $6.90
| Professional | | $3.93 | $6.90 | $6.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.15 / $10.76 / $12.63
| Professional | | $8.15 | $10.76 | $12.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $6.90 / $8.63
| Professional | | $5.75 | $6.90 | $8.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.42 / $6.90 / $9.76
| Professional | | $2.42 | $6.90 | $9.76 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.44 / $9.13 / $12.94
| Professional | | $6.44 | $9.13 | $12.94 |