- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.13 / $9.77 / $11.75
| Facility | | $8.13 | $9.77 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $8.91 / $8.91
| Professional | | $6.03 | $8.91 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $7.76 / $11.75
| Professional | | $7.76 | $7.76 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $24.55 / $24.55
| Professional | | $16.98 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $11.75 / $14.79
| Professional | | $10.00 | $11.75 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.17 / $13.80 / $19.05
| Professional | | $4.17 | $13.80 | $19.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $16.98 / $25.12
| Professional | | $8.32 | $16.98 | $25.12 |