- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.62 / $6.76 / $8.13
| Facility | | $5.62 | $6.76 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $6.03 / $6.03
| Professional | | $5.01 | $6.03 | $6.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $5.50 / $8.13
| Professional | | $5.50 | $5.50 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $15.14 / $16.60
| Professional | | $11.75 | $15.14 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $8.13 / $10.23
| Professional | | $6.76 | $8.13 | $10.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.88 / $9.55 / $13.18
| Professional | | $2.88 | $9.55 | $13.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $12.30 / $16.98
| Professional | | $7.59 | $12.30 | $16.98 |