- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.03 / $4.55 / $4.83
| Facility | | $4.03 | $4.55 | $4.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.59 / $2.59 / $5.84
| Professional | | $2.59 | $2.59 | $5.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.93 / $3.93 / $3.93
| Professional | | $3.93 | $3.93 | $3.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.97 / $10.51 / $12.28
| Professional | | $7.97 | $10.51 | $12.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.88 / $5.86 / $7.32
| Professional | | $4.88 | $5.86 | $7.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.04 / $5.86 / $9.49
| Professional | | $2.04 | $5.86 | $9.49 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.51 / $9.15 / $12.29
| Professional | | $7.51 | $9.15 | $12.29 |