- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.78 / $6.55 / $6.94
| Facility | | $5.78 | $6.55 | $6.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $8.11 / $8.41
| Professional | | $3.72 | $8.11 | $8.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $5.50 / $5.50
| Professional | | $5.50 | $5.50 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.40 / $15.04 / $17.64
| Professional | | $11.40 | $15.04 | $17.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.01 / $8.41 / $10.52
| Professional | | $7.01 | $8.41 | $10.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.94 / $8.41 / $13.61
| Professional | | $2.94 | $8.41 | $13.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.29 / $12.74 / $17.64
| Professional | | $10.29 | $12.74 | $17.64 |