- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.31 / $3.98 / $4.79
| Facility | | $3.31 | $3.98 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $3.02 / $3.02
| Professional | | $2.00 | $3.02 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.95 / $2.95 / $4.79
| Professional | | $2.95 | $2.95 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $8.13 / $8.91
| Professional | | $6.31 | $8.13 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $4.79 / $6.03
| Professional | | $3.98 | $4.79 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $5.13 / $7.08
| Professional | | $1.66 | $5.13 | $7.08 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $6.61 / $9.12
| Professional | | $4.47 | $6.61 | $9.12 |