- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.92 / $5.92 / $5.92
| Facility | | $5.92 | $5.92 | $5.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.93 / $5.93 / $5.93
| Facility | | $5.93 | $5.93 | $5.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.43 / $6.43 / $6.43
| Professional | | $6.43 | $6.43 | $6.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.28 / $8.28 / $8.28
| Professional | | $8.28 | $8.28 | $8.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $7.72 / $9.00
| Professional | | $7.08 | $7.72 | $9.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.43 / $6.82 / $9.65
| Professional | | $6.43 | $6.82 | $9.65 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.76 / $4.05 / $6.87
| Professional | | $1.76 | $4.05 | $6.87 |