- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.24 / $8.19 / $10.52
| Facility | | $7.24 | $8.19 | $10.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.88 / $6.84 / $9.81
| Professional | | $5.88 | $6.84 | $9.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.09 / $10.52 / $19.30
| Professional | | $5.09 | $10.52 | $19.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.60 / $14.82 / $17.59
| Professional | | $12.60 | $14.82 | $17.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.77 / $10.52 / $12.28
| Professional | | $8.77 | $10.52 | $12.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.68 / $4.93 / $13.16
| Professional | | $3.68 | $4.93 | $13.16 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.82 / $14.90 / $20.63
| Professional | | $9.82 | $14.90 | $20.63 |