- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.19 / $4.75 / $6.10
| Facility | | $4.19 | $4.75 | $6.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.23 / $4.23 / $6.97
| Professional | | $4.23 | $4.23 | $6.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.73 / $6.10 / $6.10
| Professional | | $3.73 | $6.10 | $6.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.73 / $10.19 / $11.95
| Professional | | $7.73 | $10.19 | $11.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.08 / $6.10 / $7.62
| Professional | | $5.08 | $6.10 | $7.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.13 / $6.10 / $9.22
| Professional | | $2.13 | $6.10 | $9.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.69 / $8.63 / $11.95
| Professional | | $5.69 | $8.63 | $11.95 |