- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.79 / $5.75 / $6.92
| Facility | | $4.79 | $5.75 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.01 / $5.13
| Professional | | $3.98 | $5.01 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $4.47 / $6.92
| Professional | | $4.47 | $4.47 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $12.88 / $14.13
| Professional | | $10.00 | $12.88 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $6.92 / $8.71
| Professional | | $5.75 | $6.92 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $8.13 / $11.22
| Professional | | $2.40 | $8.13 | $11.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $10.47 / $14.45
| Professional | | $6.46 | $10.47 | $14.45 |