- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.63 / $4.27 / $6.03
| Facility | | $3.63 | $4.27 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.98 / $5.25
| Professional | | $3.02 | $3.98 | $5.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.55 / $3.55 / $3.55
| Professional | | $3.55 | $3.55 | $3.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $9.55 / $10.72
| Professional | | $7.59 | $9.55 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.37 / $5.25 / $8.51
| Professional | | $4.37 | $5.25 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.82 / $6.03 / $6.46
| Professional | | $1.82 | $6.03 | $6.46 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $7.59 / $8.71
| Professional | | $6.31 | $7.59 | $8.71 |