- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.68 / $7.57 / $9.72
| Facility | | $6.68 | $7.57 | $9.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.16 / $8.16 / $8.16
| Professional | | $8.16 | $8.16 | $8.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $9.72 / $9.72
| Professional | | $5.50 | $9.72 | $9.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $14.98 / $17.57
| Professional | | $11.36 | $14.98 | $17.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.10 / $9.72 / $11.34
| Professional | | $8.10 | $9.72 | $11.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.72 / $9.72 / $12.15
| Professional | | $9.72 | $9.72 | $12.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.56 / $13.90 / $18.23
| Professional | | $9.56 | $13.90 | $18.23 |