- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.82 / $3.39 / $4.07
| Facility | | $2.82 | $3.39 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $3.02 / $3.02
| Professional | | $2.00 | $3.02 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $2.75 / $4.07
| Professional | | $2.75 | $2.75 | $4.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.89 / $7.59 / $8.51
| Professional | | $5.89 | $7.59 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.47 / $4.07 / $6.76
| Professional | | $3.47 | $4.07 | $6.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.45 / $4.79 / $6.61
| Professional | | $1.45 | $4.79 | $6.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.80 / $6.17 / $8.71
| Professional | | $3.80 | $6.17 | $8.71 |