- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.63 / $4.11 / $5.28
| Facility | | $3.63 | $4.11 | $5.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.73 / $4.84 / $6.04
| Professional | | $3.73 | $4.84 | $6.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.53 / $5.28 / $5.28
| Professional | | $3.53 | $5.28 | $5.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.16 / $9.44 / $11.10
| Professional | | $7.16 | $9.44 | $11.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.40 / $5.28 / $6.60
| Professional | | $4.40 | $5.28 | $6.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.85 / $5.28 / $8.53
| Professional | | $1.85 | $5.28 | $8.53 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.93 / $8.10 / $11.09
| Professional | | $4.93 | $8.10 | $11.09 |