- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.38 / $7.23 / $9.27
| Facility | | $6.38 | $7.23 | $9.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.94 / $9.02 / $10.61
| Professional | | $8.94 | $9.02 | $10.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.09 / $9.27 / $9.27
| Professional | | $6.09 | $9.27 | $9.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.58 / $16.60 / $19.42
| Professional | | $12.58 | $16.60 | $19.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.73 / $9.27 / $11.60
| Professional | | $7.73 | $9.27 | $11.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.25 / $9.27 / $15.02
| Professional | | $3.25 | $9.27 | $15.02 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.66 / $14.05 / $19.46
| Professional | | $8.66 | $14.05 | $19.46 |