- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.63 / $3.89 / $4.68
| Facility | | $3.63 | $3.89 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $3.55 / $9.77
| Professional | | $2.00 | $3.55 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.16 / $3.16 / $3.16
| Professional | | $3.16 | $3.16 | $3.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $8.71 / $9.55
| Professional | | $6.76 | $8.71 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.89 / $4.68 / $7.59
| Professional | | $3.89 | $4.68 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.34 / $5.50 / $5.89
| Professional | | $2.34 | $5.50 | $5.89 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $6.76 / $7.76
| Professional | | $5.75 | $6.76 | $7.76 |