- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.03 / $6.83 / $8.77
| Facility | | $6.03 | $6.83 | $8.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.52 / $8.52 / $8.52
| Professional | | $8.52 | $8.52 | $8.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.89 / $8.77 / $8.77
| Professional | | $5.89 | $8.77 | $8.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.87 / $15.66 / $18.36
| Professional | | $11.87 | $15.66 | $18.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.31 / $8.77 / $10.97
| Professional | | $7.31 | $8.77 | $10.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.07 / $8.77 / $14.19
| Professional | | $3.07 | $8.77 | $14.19 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.19 / $13.27 / $18.38
| Professional | | $8.19 | $13.27 | $18.38 |