- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.20 / $1.89 / $3.28
| Professional | | $1.20 | $1.89 | $3.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.44 / $3.44 / $3.44
| Facility | | $3.44 | $3.44 | $3.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.77 / $3.06 / $5.17
| Professional | | $1.77 | $3.06 | $5.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.33 / $4.53 / $4.53
| Professional | | $4.33 | $4.53 | $4.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.03 / $4.33 / $6.06
| Professional | | $3.03 | $4.33 | $6.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.44 / $3.34 / $5.40
| Professional | | $1.44 | $3.34 | $5.40 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.49 / $3.61 / $4.12
| Professional | | $3.49 | $3.61 | $4.12 |