- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.17 / $7.41 / $8.98
| Facility | | $6.17 | $7.41 | $8.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.48 / $8.25 / $41.00
| Professional | | $7.48 | $8.25 | $41.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $8.98 / $8.98
| Professional | | $5.50 | $8.98 | $8.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.21 / $14.79 / $17.28
| Professional | | $11.21 | $14.79 | $17.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.48 / $8.98 / $11.22
| Professional | | $7.48 | $8.98 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.14 / $8.98 / $13.38
| Professional | | $3.14 | $8.98 | $13.38 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.38 / $12.52 / $17.32
| Professional | | $8.38 | $12.52 | $17.32 |