- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.36 / $7.21 / $9.25
| Facility | | $6.36 | $7.21 | $9.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.23 / $16.95 / $41.17
| Professional | | $9.23 | $16.95 | $41.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.09 / $9.25 / $9.25
| Professional | | $6.09 | $9.25 | $9.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.54 / $16.53 / $19.36
| Professional | | $12.54 | $16.53 | $19.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.71 / $9.25 / $11.57
| Professional | | $7.71 | $9.25 | $11.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.25 / $9.25 / $11.57
| Professional | | $9.25 | $9.25 | $11.57 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.64 / $14.00 / $19.39
| Professional | | $8.64 | $14.00 | $19.39 |