- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.37 / $5.25 / $38.90
| Facility | | $4.37 | $5.25 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.01 / $6.31
| Professional | | $3.98 | $5.01 | $6.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.07 / $4.07 / $4.07
| Professional | | $4.07 | $4.07 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.12 / $11.75 / $12.88
| Professional | | $9.12 | $11.75 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $6.31 / $8.71
| Professional | | $5.25 | $6.31 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.24 / $7.41 / $10.23
| Professional | | $2.24 | $7.41 | $10.23 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $9.12 / $10.47
| Professional | | $7.76 | $9.12 | $10.47 |