- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.31 / $7.59 / $9.33
| Facility | | $6.31 | $7.59 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $7.08 / $7.94
| Professional | | $6.03 | $7.08 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $7.08 / $9.33
| Professional | | $7.08 | $7.08 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $19.50 / $21.88
| Professional | | $15.14 | $19.50 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $9.33 / $11.48
| Professional | | $7.76 | $9.33 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.24 / $11.48 / $16.98
| Professional | | $3.24 | $11.48 | $16.98 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $15.85 / $22.39
| Professional | | $8.71 | $15.85 | $22.39 |