- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.67 / $3.88 / $4.70
| Facility | | $3.67 | $3.88 | $4.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.53 / $4.30 / $9.86
| Professional | | $3.53 | $4.30 | $9.86 |
- 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
- $3.92 / $4.70 / $5.88
| Professional | | $3.92 | $4.70 | $5.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.35 / $4.70 / $7.61
| Professional | | $2.35 | $4.70 | $7.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $6.78 / $7.78
| Professional | | $5.75 | $6.78 | $7.78 |