- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.03 / $9.11 / $11.69
| Facility | | $8.03 | $9.11 | $11.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.87 / $11.69 / $11.69
| Professional | | $6.87 | $11.69 | $11.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.00 / $18.46 / $21.57
| Professional | | $14.00 | $18.46 | $21.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.74 / $11.69 / $14.61
| Professional | | $9.74 | $11.69 | $14.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.09 / $11.69 / $16.72
| Professional | | $4.09 | $11.69 | $16.72 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.91 / $15.64 / $21.92
| Professional | | $10.91 | $15.64 | $21.92 |