- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.88 / $8.93 / $11.46
| Facility | | $7.88 | $8.93 | $11.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.26 / $7.26 / $7.26
| Professional | | $7.26 | $7.26 | $7.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $11.46 / $11.46
| Professional | | $6.48 | $11.46 | $11.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.28 / $17.53 / $20.47
| Professional | | $13.28 | $17.53 | $20.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $11.46 / $14.33
| Professional | | $9.55 | $11.46 | $14.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.01 / $11.46 / $15.85
| Professional | | $4.01 | $11.46 | $15.85 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.70 / $14.83 / $21.11
| Professional | | $10.70 | $14.83 | $21.11 |