- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.10 / $2.50 / $3.05
| Facility | | $2.10 | $2.50 | $3.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.29 / $2.79 / $3.48
| Professional | | $2.29 | $2.79 | $3.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.96 / $3.05 / $3.05
| Professional | | $1.96 | $3.05 | $3.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.15 / $5.47 / $6.42
| Professional | | $4.15 | $5.47 | $6.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $3.05 / $3.81
| Professional | | $2.54 | $3.05 | $3.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.07 / $3.05 / $4.93
| Professional | | $1.07 | $3.05 | $4.93 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.84 / $4.62 / $6.39
| Professional | | $2.84 | $4.62 | $6.39 |