- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.62 / $6.62 / $6.62
| Facility | | $6.62 | $6.62 | $6.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $2.75 / $2.75
| Professional | | $2.75 | $2.75 | $2.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.61 / $6.61 / $6.61
| Facility | | $6.61 | $6.61 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.73 / $2.73 / $2.73
| Professional | | $2.73 | $2.73 | $2.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.23 / $3.23 / $3.23
| Professional | | $3.23 | $3.23 | $3.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $3.27 / $3.82
| Professional | | $3.00 | $3.27 | $3.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $2.73 / $4.09
| Professional | | $2.65 | $2.73 | $4.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.23 / $2.85 / $5.18
| Professional | | $2.23 | $2.85 | $5.18 |