- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.79 / $2.02 / $2.60
| Facility | | $1.79 | $2.02 | $2.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.50 / $2.52 / $2.98
| Professional | | $2.50 | $2.52 | $2.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.77 / $2.60 / $2.60
| Professional | | $1.77 | $2.60 | $2.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.54 / $4.67 / $5.41
| Professional | | $3.54 | $4.67 | $5.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.17 / $2.60 / $3.26
| Professional | | $2.17 | $2.60 | $3.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.30 / $2.60 / $4.20
| Professional | | $1.30 | $2.60 | $4.20 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.43 / $3.94 / $5.45
| Professional | | $2.43 | $3.94 | $5.45 |