- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.45 / $5.04 / $6.47
| Facility | | $4.45 | $5.04 | $6.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.21 / $6.26 / $43.00
| Professional | | $6.21 | $6.26 | $43.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.32 / $6.47 / $6.47
| Professional | | $4.32 | $6.47 | $6.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.72 / $11.50 / $13.48
| Professional | | $8.72 | $11.50 | $13.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.39 / $6.47 / $8.09
| Professional | | $5.39 | $6.47 | $8.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $6.47 / $10.45
| Professional | | $2.25 | $6.47 | $10.45 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.04 / $9.75 / $13.50
| Professional | | $6.04 | $9.75 | $13.50 |