- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.24 / $3.89 / $4.72
| Facility | | $3.24 | $3.89 | $4.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.53 / $4.32 / $5.39
| Professional | | $3.53 | $4.32 | $5.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.14 / $3.14 / $3.14
| Professional | | $3.14 | $3.14 | $3.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.36 / $8.40 / $9.84
| Professional | | $6.36 | $8.40 | $9.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.93 / $4.72 / $5.90
| Professional | | $3.93 | $4.72 | $5.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.36 / $4.72 / $7.62
| Professional | | $2.36 | $4.72 | $7.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $6.78 / $7.80
| Professional | | $5.75 | $6.78 | $7.80 |