- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.55 / $4.27 / $5.13
| Facility | | $3.55 | $4.27 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.98 / $3.98
| Professional | | $3.02 | $3.98 | $3.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $3.31 / $5.13
| Professional | | $3.31 | $3.31 | $5.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $9.55 / $10.47
| Professional | | $7.41 | $9.55 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.27 / $5.13 / $8.32
| Professional | | $4.27 | $5.13 | $8.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.82 / $6.03 / $8.32
| Professional | | $1.82 | $6.03 | $8.32 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.79 / $7.76 / $10.72
| Professional | | $4.79 | $7.76 | $10.72 |