- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.82 / $7.82 / $7.82
| Facility | | $7.82 | $7.82 | $7.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.29 / $5.30 / $9.86
| Professional | | $5.29 | $5.30 | $9.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.82 / $7.82 / $7.82
| Facility | | $7.82 | $7.82 | $7.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.55 / $5.30 / $5.80
| Professional | | $4.55 | $5.30 | $5.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.01 / $6.01 / $6.01
| Professional | | $6.01 | $6.01 | $6.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.30 / $6.36 / $7.95
| Professional | | $5.30 | $6.36 | $7.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.93 / $5.30 / $7.95
| Professional | | $4.93 | $5.30 | $7.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.75 / $4.67 / $5.84
| Professional | | $2.75 | $4.67 | $5.84 |