- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.65 / $7.54 / $9.67
| Facility | | $6.65 | $7.54 | $9.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.06 / $8.06 / $8.06
| Professional | | $8.06 | $8.06 | $8.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $9.67 / $9.67
| Professional | | $6.48 | $9.67 | $9.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.10 / $17.28 / $20.28
| Professional | | $13.10 | $17.28 | $20.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.06 / $9.67 / $12.09
| Professional | | $8.06 | $9.67 | $12.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $9.67 / $15.65
| Professional | | $3.39 | $9.67 | $15.65 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $14.65 / $20.29
| Professional | | $9.02 | $14.65 | $20.29 |