- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.46 / $7.76 / $9.33
| Facility | | $6.46 | $7.76 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $7.08 / $9.33
| Professional | | $5.01 | $7.08 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $6.31 / $9.33
| Professional | | $6.31 | $6.31 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $17.38 / $19.50
| Professional | | $13.49 | $17.38 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $9.33 / $15.49
| Professional | | $7.94 | $9.33 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $10.96 / $15.14
| Professional | | $3.31 | $10.96 | $15.14 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $14.13 / $19.95
| Professional | | $8.71 | $14.13 | $19.95 |