- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.79 / $8.83 / $11.33
| Facility | | $7.79 | $8.83 | $11.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.46 / $11.33 / $11.33
| Professional | | $7.46 | $11.33 | $11.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.36 / $20.26 / $23.64
| Professional | | $15.36 | $20.26 | $23.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.44 / $11.33 / $14.16
| Professional | | $9.44 | $11.33 | $14.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.96 / $11.33 / $18.32
| Professional | | $3.96 | $11.33 | $18.32 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.57 / $17.13 / $23.72
| Professional | | $10.57 | $17.13 | $23.72 |