- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.31 / $3.75 / $4.80
| Facility | | $3.31 | $3.75 | $4.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $2.81 / $5.50
| Professional | | $2.72 | $2.81 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.96 / $4.80 / $4.80
| Professional | | $1.96 | $4.80 | $4.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.86 / $5.09 / $5.94
| Professional | | $3.86 | $5.09 | $5.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.01 / $4.80 / $6.02
| Professional | | $4.01 | $4.80 | $6.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.30 / $4.80 / $4.80
| Professional | | $3.30 | $4.80 | $4.80 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.47 / $4.69 / $7.02
| Professional | | $3.47 | $4.69 | $7.02 |