- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.84 / $5.50 / $7.06
| Facility | | $4.84 | $5.50 | $7.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.80 / $8.07 / $36.86
| Professional | | $6.80 | $8.07 | $36.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.71 / $7.06 / $7.06
| Professional | | $4.71 | $7.06 | $7.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.57 / $12.62 / $14.79
| Professional | | $9.57 | $12.62 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.88 / $7.06 / $8.82
| Professional | | $5.88 | $7.06 | $8.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.47 / $7.06 / $11.41
| Professional | | $2.47 | $7.06 | $11.41 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.59 / $10.69 / $14.80
| Professional | | $6.59 | $10.69 | $14.80 |