- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.98 / $4.79 / $5.89
| Facility | | $3.98 | $4.79 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.98 / $3.98
| Professional | | $3.02 | $3.98 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.89 / $3.89 / $5.89
| Professional | | $3.89 | $3.89 | $5.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $10.72 / $12.02
| Professional | | $8.32 | $10.72 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.90 / $5.89 / $7.24
| Professional | | $4.90 | $5.89 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $6.76 / $9.33
| Professional | | $2.04 | $6.76 | $9.33 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $8.71 / $12.30
| Professional | | $5.50 | $8.71 | $12.30 |