- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.79 / $8.83 / $11.33
| Facility | | $7.79 | $8.83 | $11.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $11.33 / $11.33
| Professional | | $5.50 | $11.33 | $11.33 |
- 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
- $9.44 / $11.33 / $14.16
| Professional | | $9.44 | $11.33 | $14.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.96 / $11.33 / $14.16
| Professional | | $3.96 | $11.33 | $14.16 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.10 / $12.74 / $20.41
| Professional | | $10.10 | $12.74 | $20.41 |