- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.56 / $4.03 / $5.17
| Facility | | $3.56 | $4.03 | $5.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.34 / $5.17 / $5.17
| Professional | | $3.34 | $5.17 | $5.17 |
- 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
- $4.30 / $5.17 / $6.47
| Professional | | $4.30 | $5.17 | $6.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.17 / $5.17 / $6.47
| Professional | | $5.17 | $5.17 | $6.47 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.83 / $7.75 / $10.73
| Professional | | $4.83 | $7.75 | $10.73 |