- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.07 / $5.74 / $7.37
| Facility | | $5.07 | $5.74 | $7.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.62 / $6.75 / $6.78
| Professional | | $6.62 | $6.75 | $6.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.51 / $7.37 / $7.37
| Professional | | $4.51 | $7.37 | $7.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.23 / $12.18 / $14.27
| Professional | | $9.23 | $12.18 | $14.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.14 / $7.37 / $9.21
| Professional | | $6.14 | $7.37 | $9.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.58 / $7.37 / $11.02
| Professional | | $2.58 | $7.37 | $11.02 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.14 / $10.23 / $14.27
| Professional | | $6.14 | $10.23 | $14.27 |