- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.32 / $9.43 / $12.11
| Facility | | $8.32 | $9.43 | $12.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.09 / $12.11 / $12.11
| Professional | | $6.09 | $12.11 | $12.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.54 / $16.53 / $19.36
| Professional | | $12.54 | $16.53 | $19.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.09 / $12.11 / $15.14
| Professional | | $10.09 | $12.11 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.24 / $12.11 / $15.14
| Professional | | $4.24 | $12.11 | $15.14 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.30 / $14.18 / $19.91
| Professional | | $11.30 | $14.18 | $19.91 |