- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.17 / $5.01 / $6.03
| Facility | | $4.17 | $5.01 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.98 / $4.68
| Professional | | $3.02 | $3.98 | $4.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.89 / $3.89 / $6.03
| Professional | | $3.89 | $3.89 | $6.03 |
- 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
- $5.01 / $6.03 / $7.59
| Professional | | $5.01 | $6.03 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $7.59 / $9.77
| Professional | | $3.02 | $7.59 | $9.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.27 / $7.41 / $11.22
| Professional | | $4.27 | $7.41 | $11.22 |