- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.74 / $8.09 / $9.80
| Facility | | $6.74 | $8.09 | $9.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $9.55 / $9.55
| Professional | | $9.55 | $9.55 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $6.48 / $6.48
| Professional | | $6.48 | $6.48 | $6.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.28 / $17.53 / $20.54
| Professional | | $13.28 | $17.53 | $20.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.17 / $9.80 / $12.26
| Professional | | $8.17 | $9.80 | $12.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.90 / $9.80 / $15.86
| Professional | | $4.90 | $9.80 | $15.86 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.99 / $14.11 / $16.23
| Professional | | $11.99 | $14.11 | $16.23 |