- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.76 / $7.66 / $9.83
| Facility | | $6.76 | $7.66 | $9.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.43 / $9.01 / $26.81
| Professional | | $7.43 | $9.01 | $26.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $6.48 / $6.48
| Professional | | $6.48 | $6.48 | $6.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.34 / $17.59 / $20.54
| Professional | | $13.34 | $17.59 | $20.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.19 / $9.83 / $12.29
| Professional | | $8.19 | $9.83 | $12.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.44 / $9.83 / $15.90
| Professional | | $3.44 | $9.83 | $15.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.01 / $14.14 / $16.27
| Professional | | $12.01 | $14.14 | $16.27 |