- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.01 / $6.03 / $7.24
| Facility | | $5.01 | $6.03 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.98 / $5.01
| Professional | | $3.02 | $3.98 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.89 / $3.89 / $7.24
| Professional | | $3.89 | $3.89 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $11.22 / $12.30
| Professional | | $8.71 | $11.22 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $7.24 / $9.12
| Professional | | $6.03 | $7.24 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.51 / $7.24 / $9.77
| Professional | | $2.51 | $7.24 | $9.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $9.12 / $12.88
| Professional | | $6.76 | $9.12 | $12.88 |