- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.27 / $5.13 / $7.08
| Facility | | $4.27 | $5.13 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $5.01 / $18.62
| Professional | | $3.02 | $5.01 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.07 / $4.07 / $4.07
| Professional | | $4.07 | $4.07 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $11.48 / $12.88
| Professional | | $8.91 | $11.48 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.13 / $6.17 / $9.33
| Professional | | $5.13 | $6.17 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.19 / $7.24 / $7.76
| Professional | | $2.19 | $7.24 | $7.76 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $9.77 / $12.88
| Professional | | $7.94 | $9.77 | $12.88 |