- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.68 / $5.62 / $6.92
| Facility | | $4.68 | $5.62 | $6.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $5.01 / $5.01
| Professional | | $3.98 | $5.01 | $5.01 |
- 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
- $9.77 / $12.59 / $14.13
| Professional | | $9.77 | $12.59 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $6.92 / $8.51
| Professional | | $5.75 | $6.92 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $7.94 / $11.22
| Professional | | $2.40 | $7.94 | $11.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $10.23 / $14.45
| Professional | | $6.46 | $10.23 | $14.45 |