- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.29 / $3.95 / $4.79
| Facility | | $3.29 | $3.95 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.49 / $3.99 / $4.79
| Professional | | $3.49 | $3.99 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.14 / $4.79 / $4.79
| Professional | | $3.14 | $4.79 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.51 / $8.58 / $10.05
| Professional | | $6.51 | $8.58 | $10.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.99 / $4.79 / $5.99
| Professional | | $3.99 | $4.79 | $5.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.68 / $4.79 / $7.77
| Professional | | $1.68 | $4.79 | $7.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $7.27 / $10.06
| Professional | | $4.47 | $7.27 | $10.06 |