- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.97 / $4.76 / $5.77
| Facility | | $3.97 | $4.76 | $5.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.80 / $5.56 / $6.60
| Professional | | $4.80 | $5.56 | $6.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.73 / $3.73 / $3.73
| Professional | | $3.73 | $3.73 | $3.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.82 / $10.32 / $12.10
| Professional | | $7.82 | $10.32 | $12.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.80 / $5.77 / $7.22
| Professional | | $4.80 | $5.77 | $7.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $5.77 / $9.35
| Professional | | $2.02 | $5.77 | $9.35 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.32 / $9.00 / $12.10
| Professional | | $7.32 | $9.00 | $12.10 |