- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.34 / $6.05 / $7.76
| Facility | | $5.34 | $6.05 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.49 / $8.88 / $41.00
| Professional | | $7.49 | $8.88 | $41.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.09 / $7.76 / $7.76
| Professional | | $5.09 | $7.76 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.51 / $13.87 / $16.25
| Professional | | $10.51 | $13.87 | $16.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.47 / $7.76 / $9.06
| Professional | | $6.47 | $7.76 | $9.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $7.76 / $12.55
| Professional | | $2.72 | $7.76 | $12.55 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.25 / $11.75 / $16.27
| Professional | | $7.25 | $11.75 | $16.27 |