- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.26 / $8.23 / $10.56
| Facility | | $7.26 | $8.23 | $10.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $10.56 / $10.56
| Professional | | $6.48 | $10.56 | $10.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.47 / $17.77 / $20.75
| Professional | | $13.47 | $17.77 | $20.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.80 / $10.56 / $13.20
| Professional | | $8.80 | $10.56 | $13.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.70 / $10.56 / $16.05
| Professional | | $3.70 | $10.56 | $16.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $15.03 / $20.81
| Professional | | $9.86 | $15.03 | $20.81 |