- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.81 / $8.85 / $11.36
| Facility | | $7.81 | $8.85 | $11.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.67 / $11.36 / $11.36
| Professional | | $6.67 | $11.36 | $11.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.76 / $17.23 / $21.29
| Professional | | $13.76 | $17.23 | $21.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.47 / $11.36 / $14.21
| Professional | | $9.47 | $11.36 | $14.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $11.36 / $16.43
| Professional | | $3.98 | $11.36 | $16.43 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.61 / $15.38 / $21.31
| Professional | | $10.61 | $15.38 | $21.31 |