- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.89 / $4.68 / $6.46
| Facility | | $3.89 | $4.68 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.98 / $5.25
| Professional | | $3.02 | $3.98 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $3.72 / $3.72
| Professional | | $3.72 | $3.72 | $3.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $10.23 / $11.22
| Professional | | $7.94 | $10.23 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.79 / $5.75 / $9.33
| Professional | | $4.79 | $5.75 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $6.46 / $8.91
| Professional | | $2.00 | $6.46 | $8.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.92 / $8.51 / $11.48
| Professional | | $6.92 | $8.51 | $11.48 |