- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.52 / $8.52 / $10.93
| Facility | | $7.52 | $8.52 | $10.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.07 / $10.93 / $10.93
| Professional | | $7.07 | $10.93 | $10.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.46 / $19.09 / $22.32
| Professional | | $14.46 | $19.09 | $22.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.11 / $10.93 / $13.67
| Professional | | $9.11 | $10.93 | $13.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.83 / $10.93 / $17.27
| Professional | | $3.83 | $10.93 | $17.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.19 / $16.14 / $22.36
| Professional | | $10.19 | $16.14 | $22.36 |