- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.79 / $5.75 / $7.08
| Facility | | $4.79 | $5.75 | $7.08 |
- 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
- $4.68 / $4.68 / $7.08
| Professional | | $4.68 | $4.68 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $13.18 / $14.45
| Professional | | $10.23 | $13.18 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.89 / $7.08 / $11.48
| Professional | | $5.89 | $7.08 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.45 / $8.13 / $11.48
| Professional | | $2.45 | $8.13 | $11.48 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.61 / $10.72 / $14.79
| Professional | | $6.61 | $10.72 | $14.79 |