- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.57 / $5.50 / $6.61
| Facility | | $4.57 | $5.50 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.98 / $5.01
| Professional | | $3.02 | $3.98 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $3.72 / $6.61
| Professional | | $3.72 | $3.72 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $10.47 / $11.75
| Professional | | $8.13 | $10.47 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $6.61 / $8.32
| Professional | | $5.62 | $6.61 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $6.61 / $9.12
| Professional | | $2.34 | $6.61 | $9.12 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.17 / $8.71 / $12.30
| Professional | | $6.17 | $8.71 | $12.30 |