- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.99 / $5.66 / $7.26
| Facility | | $4.99 | $5.66 | $7.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.71 / $7.26 / $7.26
| Professional | | $4.71 | $7.26 | $7.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.85 / $13.00 / $15.20
| Professional | | $9.85 | $13.00 | $15.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.05 / $7.26 / $9.08
| Professional | | $6.05 | $7.26 | $9.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $7.26 / $11.74
| Professional | | $2.54 | $7.26 | $11.74 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.78 / $11.01 / $15.25
| Professional | | $6.78 | $11.01 | $15.25 |