- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.02 / $7.23 / $8.76
| Facility | | $6.02 | $7.23 | $8.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.37 / $7.30 / $8.02
| Professional | | $6.37 | $7.30 | $8.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.69 / $8.76 / $8.76
| Professional | | $5.69 | $8.76 | $8.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.87 / $15.66 / $18.30
| Professional | | $11.87 | $15.66 | $18.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.30 / $8.76 / $10.95
| Professional | | $7.30 | $8.76 | $10.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.07 / $8.76 / $14.18
| Professional | | $3.07 | $8.76 | $14.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.18 / $13.26 / $18.36
| Professional | | $8.18 | $13.26 | $18.36 |