- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.67 / $6.80 / $8.24
| Facility | | $5.67 | $6.80 | $8.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.90 / $6.22 / $8.02
| Professional | | $5.90 | $6.22 | $8.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $8.24 / $8.24
| Professional | | $5.50 | $8.24 | $8.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.17 / $14.74 / $17.23
| Professional | | $11.17 | $14.74 | $17.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.87 / $8.24 / $10.31
| Professional | | $6.87 | $8.24 | $10.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.89 / $8.24 / $13.32
| Professional | | $2.89 | $8.24 | $13.32 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.87 / $12.40 / $17.30
| Professional | | $6.87 | $12.40 | $17.30 |