- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.76 / $4.26 / $5.47
| Facility | | $3.76 | $4.26 | $5.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.53 / $5.47 / $5.47
| Professional | | $3.53 | $5.47 | $5.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.40 / $9.76 / $11.42
| Professional | | $7.40 | $9.76 | $11.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.55 / $5.47 / $6.84
| Professional | | $4.55 | $5.47 | $6.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.92 / $5.47 / $8.84
| Professional | | $1.92 | $5.47 | $8.84 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.11 / $8.26 / $11.43
| Professional | | $5.11 | $8.26 | $11.43 |