- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.57 / $5.50 / $6.61
| Facility | | $4.57 | $5.50 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.01 / $5.01
| Professional | | $3.98 | $5.01 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.37 / $4.37 / $6.61
| Professional | | $4.37 | $4.37 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $12.30 / $13.49
| Professional | | $9.55 | $12.30 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $6.61 / $8.32
| Professional | | $5.50 | $6.61 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.61 / $10.72 / $33.11
| Professional | | $6.61 | $10.72 | $33.11 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.17 / $10.00 / $13.80
| Professional | | $6.17 | $10.00 | $13.80 |