- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.77 / $7.67 / $9.84
| Facility | | $6.77 | $7.67 | $9.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.56 / $8.56 / $8.56
| Professional | | $8.56 | $8.56 | $8.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.89 / $9.84 / $9.84
| Professional | | $5.89 | $9.84 | $9.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.93 / $15.73 / $18.36
| Professional | | $11.93 | $15.73 | $18.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.19 / $9.84 / $12.30
| Professional | | $8.19 | $9.84 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.44 / $9.84 / $14.22
| Professional | | $3.44 | $9.84 | $14.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.18 / $13.30 / $18.45
| Professional | | $9.18 | $13.30 | $18.45 |