- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.76 / $5.71 / $6.92
| Facility | | $4.76 | $5.71 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.16 / $5.16 / $5.16
| Professional | | $5.16 | $5.16 | $5.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.51 / $6.92 / $6.92
| Professional | | $4.51 | $6.92 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.38 / $12.37 / $14.53
| Professional | | $9.38 | $12.37 | $14.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.77 / $6.92 / $8.66
| Professional | | $5.77 | $6.92 | $8.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.92 / $6.92 / $8.66
| Professional | | $6.92 | $6.92 | $8.66 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $10.49 / $14.53
| Professional | | $6.46 | $10.49 | $14.53 |