- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.24 / $3.89 / $4.79
| Facility | | $3.24 | $3.89 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.55 / $4.79
| Professional | | $3.02 | $3.55 | $4.79 |
- 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 / $9.77
| Professional | | $6.76 | $8.71 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $4.79 / $7.76
| Professional | | $3.98 | $4.79 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.66 / $5.50 / $7.59
| Professional | | $1.66 | $5.50 | $7.59 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $7.41 / $10.00
| Professional | | $6.03 | $7.41 | $10.00 |