- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.72 / $4.47 / $6.17
| Facility | | $3.72 | $4.47 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.98 / $11.22
| Professional | | $3.02 | $3.98 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.55 / $3.55 / $5.37
| Professional | | $3.55 | $3.55 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $10.00 / $10.96
| Professional | | $7.76 | $10.00 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $5.37 / $8.71
| Professional | | $4.47 | $5.37 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.86 / $6.31 / $8.71
| Professional | | $1.86 | $6.31 | $8.71 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $8.13 / $11.22
| Professional | | $5.01 | $8.13 | $11.22 |