- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.76 / $5.72 / $6.94
| Facility | | $4.76 | $5.72 | $6.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.61 / $4.61 / $7.93
| Professional | | $4.61 | $4.61 | $7.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $6.94 / $6.94
| Professional | | $4.12 | $6.94 | $6.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.43 / $11.13 / $13.02
| Professional | | $8.43 | $11.13 | $13.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.78 / $6.94 / $8.67
| Professional | | $5.78 | $6.94 | $8.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.43 / $6.94 / $10.05
| Professional | | $2.43 | $6.94 | $10.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.47 / $9.33 / $13.01
| Professional | | $6.47 | $9.33 | $13.01 |