- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.02 / $9.09 / $11.66
| Facility | | $8.02 | $9.09 | $11.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.69 / $11.66 / $11.66
| Professional | | $5.69 | $11.66 | $11.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.59 / $15.29 / $17.88
| Professional | | $11.59 | $15.29 | $17.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.72 / $11.66 / $14.58
| Professional | | $9.72 | $11.66 | $14.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.08 / $11.66 / $14.58
| Professional | | $4.08 | $11.66 | $14.58 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.72 / $13.12 / $18.44
| Professional | | $9.72 | $13.12 | $18.44 |