- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.03 / $7.24 / $8.71
| Facility | | $6.03 | $7.24 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $6.03 / $7.08
| Professional | | $5.01 | $6.03 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $5.75 / $8.71
| Professional | | $5.75 | $5.75 | $8.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $16.22 / $17.78
| Professional | | $12.59 | $16.22 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.24 / $8.71 / $10.96
| Professional | | $7.24 | $8.71 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.09 / $10.23 / $14.13
| Professional | | $3.09 | $10.23 | $14.13 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $13.18 / $18.20
| Professional | | $8.13 | $13.18 | $18.20 |