- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.71 / $3.07 / $3.94
| Facility | | $2.71 | $3.07 | $3.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.96 / $3.94 / $3.94
| Professional | | $1.96 | $3.94 | $3.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.05 / $5.34 / $6.26
| Professional | | $4.05 | $5.34 | $6.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.28 / $3.94 / $4.92
| Professional | | $3.28 | $3.94 | $4.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.38 / $3.94 / $4.92
| Professional | | $1.38 | $3.94 | $4.92 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.67 / $4.62 / $6.48
| Professional | | $3.67 | $4.62 | $6.48 |