- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.88 / $4.38 / $5.64
| Facility | | $3.88 | $4.38 | $5.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.94 / $5.64 / $5.64
| Professional | | $2.94 | $5.64 | $5.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.42 / $7.15 / $8.38
| Professional | | $5.42 | $7.15 | $8.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.70 / $5.64 / $7.05
| Professional | | $4.70 | $5.64 | $7.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.15 / $5.64 / $7.05
| Professional | | $5.15 | $5.64 | $7.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.90 / $6.26 / $8.64
| Professional | | $4.90 | $6.26 | $8.64 |