- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.55 / $5.15 / $6.61
| Facility | | $4.55 | $5.15 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.80 / $4.99 / $6.37
| Professional | | $4.80 | $4.99 | $6.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.32 / $6.61 / $6.61
| Professional | | $4.32 | $6.61 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.96 / $11.81 / $13.88
| Professional | | $8.96 | $11.81 | $13.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.51 / $6.61 / $8.27
| Professional | | $5.51 | $6.61 | $8.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.31 / $6.61 / $10.70
| Professional | | $2.31 | $6.61 | $10.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.17 / $10.15 / $13.88
| Professional | | $6.17 | $10.15 | $13.88 |