- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.52 / $4.23 / $30.10
| Facility | | $3.52 | $4.23 | $30.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.99 / $5.12 / $27.46
| Professional | | $4.99 | $5.12 | $27.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.34 / $5.12 / $5.12
| Professional | | $3.34 | $5.12 | $5.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.93 / $9.14 / $10.70
| Professional | | $6.93 | $9.14 | $10.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.26 / $5.12 / $6.41
| Professional | | $4.26 | $5.12 | $6.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $5.12 / $8.28
| Professional | | $2.56 | $5.12 | $8.28 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.78 / $7.75 / $10.73
| Professional | | $4.78 | $7.75 | $10.73 |