- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.00 / $3.40 / $4.37
| Facility | | $3.00 | $3.40 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.67 / $4.00 / $5.73
| Professional | | $2.67 | $4.00 | $5.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.36 / $4.37 / $4.37
| Professional | | $2.36 | $4.37 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.84 / $6.41 / $7.52
| Professional | | $4.84 | $6.41 | $7.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.64 / $4.37 / $5.46
| Professional | | $3.64 | $4.37 | $5.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.53 / $4.37 / $5.83
| Professional | | $1.53 | $4.37 | $5.83 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.08 / $5.45 / $7.75
| Professional | | $4.08 | $5.45 | $7.75 |