- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.96 / $7.89 / $10.13
| Facility | | $6.96 | $7.89 | $10.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.46 / $4.46 / $8.43
| Professional | | $4.46 | $4.46 | $8.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.67 / $10.13 / $10.13
| Professional | | $6.67 | $10.13 | $10.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.72 / $18.09 / $21.22
| Professional | | $13.72 | $18.09 | $21.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.44 / $10.13 / $12.66
| Professional | | $8.44 | $10.13 | $12.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.54 / $10.13 / $16.39
| Professional | | $3.54 | $10.13 | $16.39 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.44 / $15.34 / $21.24
| Professional | | $9.44 | $15.34 | $21.24 |