- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.24 / $8.71 / $10.47
| Facility | | $7.24 | $8.71 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.00 / $7.08 / $7.94
| Professional | | $2.00 | $7.08 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $6.46 / $10.47
| Professional | | $6.46 | $6.46 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $18.20 / $20.42
| Professional | | $14.45 | $18.20 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $10.47 / $13.18
| Professional | | $8.71 | $10.47 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $11.48 / $16.22
| Professional | | $3.72 | $11.48 | $16.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $14.79 / $20.89
| Professional | | $9.77 | $14.79 | $20.89 |