- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.53 / $4.00 / $5.14
| Facility | | $3.53 | $4.00 | $5.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.96 / $4.96 / $4.96
| Professional | | $4.96 | $4.96 | $4.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.34 / $5.14 / $5.14
| Professional | | $3.34 | $5.14 | $5.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.93 / $9.14 / $10.70
| Professional | | $6.93 | $9.14 | $10.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.28 / $5.14 / $6.42
| Professional | | $4.28 | $5.14 | $6.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.80 / $5.14 / $8.27
| Professional | | $1.80 | $5.14 | $8.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.79 / $7.74 / $10.71
| Professional | | $4.79 | $7.74 | $10.71 |