- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.36 / $7.21 / $9.25
| Facility | | $6.36 | $7.21 | $9.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.07 / $9.25 / $9.25
| Professional | | $7.07 | $9.25 | $9.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.37 / $18.96 / $22.18
| Professional | | $14.37 | $18.96 | $22.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.71 / $9.25 / $11.57
| Professional | | $7.71 | $9.25 | $11.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.24 / $9.25 / $17.17
| Professional | | $3.24 | $9.25 | $17.17 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.64 / $16.07 / $22.25
| Professional | | $8.64 | $16.07 | $22.25 |