- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.09 / $9.17 / $11.77
| Facility | | $8.09 | $9.17 | $11.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.26 / $11.77 / $11.77
| Professional | | $7.26 | $11.77 | $11.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.89 / $19.64 / $22.98
| Professional | | $14.89 | $19.64 | $22.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.81 / $11.77 / $14.72
| Professional | | $9.81 | $11.77 | $14.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $11.77 / $17.78
| Professional | | $4.12 | $11.77 | $17.78 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.99 / $16.64 / $23.04
| Professional | | $10.99 | $16.64 | $23.04 |