- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.37 / $6.46 / $7.76
| Facility | | $5.37 | $6.46 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $5.01 / $6.03
| Professional | | $2.00 | $5.01 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.89 / $3.89 / $7.76
| Professional | | $3.89 | $3.89 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.51 / $10.96 / $12.30
| Professional | | $8.51 | $10.96 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $7.76 / $9.77
| Professional | | $6.46 | $7.76 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $7.76 / $9.77
| Professional | | $2.75 | $7.76 | $9.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.24 / $9.12 / $12.88
| Professional | | $7.24 | $9.12 | $12.88 |