- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.17 / $5.01 / $6.03
| Facility | | $4.17 | $5.01 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $3.02 / $3.98
| Professional | | $2.00 | $3.02 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.95 / $2.95 / $6.03
| Professional | | $2.95 | $2.95 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $8.32 / $9.12
| Professional | | $6.46 | $8.32 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.13 / $6.03 / $7.59
| Professional | | $5.13 | $6.03 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.14 / $6.03 / $7.59
| Professional | | $2.14 | $6.03 | $7.59 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $6.92 / $9.55
| Professional | | $5.50 | $6.92 | $9.55 |