- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.49 / $2.82 / $3.62
| Facility | | $2.49 | $2.82 | $3.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.69 / $2.74 / $3.48
| Professional | | $2.69 | $2.74 | $3.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.36 / $3.62 / $3.62
| Professional | | $2.36 | $3.62 | $3.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.91 / $6.46 / $7.52
| Professional | | $4.91 | $6.46 | $7.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.62 / $4.53
| Professional | | $3.02 | $3.62 | $4.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.27 / $3.62 / $5.86
| Professional | | $1.27 | $3.62 | $5.86 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.38 / $5.46 / $7.56
| Professional | | $3.38 | $5.46 | $7.56 |