- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.97 / $9.02 / $11.59
| Facility | | $7.97 | $9.02 | $11.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.66 / $11.59 / $11.59
| Professional | | $7.66 | $11.59 | $11.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.69 / $20.70 / $24.23
| Professional | | $15.69 | $20.70 | $24.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.66 / $11.59 / $14.49
| Professional | | $9.66 | $11.59 | $14.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.05 / $11.59 / $18.75
| Professional | | $4.05 | $11.59 | $18.75 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.82 / $17.55 / $24.30
| Professional | | $10.82 | $17.55 | $24.30 |