- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.02 / $3.63 / $26.30
| Facility | | $3.02 | $3.63 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $3.16 / $4.37
| Professional | | $2.00 | $3.16 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.95 / $2.95 / $4.37
| Professional | | $2.95 | $2.95 | $4.37 |
- 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
- $3.63 / $4.37 / $7.08
| Professional | | $3.63 | $4.37 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.55 / $5.13 / $7.08
| Professional | | $1.55 | $5.13 | $7.08 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $6.61 / $9.12
| Professional | | $3.63 | $6.61 | $9.12 |