- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.90 / $4.42 / $5.68
| Facility | | $3.90 | $4.42 | $5.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.82 / $3.82 / $6.49
| Professional | | $3.82 | $3.82 | $6.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.34 / $5.68 / $5.68
| Professional | | $3.34 | $5.68 | $5.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.98 / $9.19 / $10.77
| Professional | | $6.98 | $9.19 | $10.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.73 / $5.68 / $7.10
| Professional | | $4.73 | $5.68 | $7.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.99 / $5.68 / $8.35
| Professional | | $1.99 | $5.68 | $8.35 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.30 / $7.81 / $10.82
| Professional | | $5.30 | $7.81 | $10.82 |