- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.47 / $3.93 / $5.04
| Facility | | $3.47 | $3.93 | $5.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.34 / $5.04 / $5.04
| Professional | | $3.34 | $5.04 | $5.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.83 / $9.02 / $10.58
| Professional | | $6.83 | $9.02 | $10.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.20 / $5.04 / $6.30
| Professional | | $4.20 | $5.04 | $6.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.76 / $5.04 / $8.17
| Professional | | $1.76 | $5.04 | $8.17 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.70 / $7.64 / $10.58
| Professional | | $4.70 | $7.64 | $10.58 |