- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.71 / $8.71 / $12.30
| Facility | | $8.71 | $8.71 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $7.94 / $9.77
| Professional | | $6.03 | $7.94 | $9.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $7.08 / $7.08
| Professional | | $7.08 | $7.08 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $19.95 / $21.88
| Professional | | $15.49 | $19.95 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $10.72 / $13.49
| Professional | | $8.91 | $10.72 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $12.30 / $17.38
| Professional | | $3.72 | $12.30 | $17.38 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $15.49 / $17.78
| Professional | | $12.88 | $15.49 | $17.78 |