- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.81 / $7.72 / $9.91
| Facility | | $6.81 | $7.72 | $9.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.69 / $9.91 / $9.91
| Professional | | $5.69 | $9.91 | $9.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.87 / $15.66 / $18.30
| Professional | | $11.87 | $15.66 | $18.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.26 / $9.91 / $12.39
| Professional | | $8.26 | $9.91 | $12.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.47 / $9.91 / $14.18
| Professional | | $3.47 | $9.91 | $14.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.25 / $13.26 / $18.59
| Professional | | $9.25 | $13.26 | $18.59 |