- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.39 / $6.11 / $7.84
| Facility | | $5.39 | $6.11 | $7.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.09 / $7.84 / $7.84
| Professional | | $5.09 | $7.84 | $7.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.65 / $14.05 / $16.38
| Professional | | $10.65 | $14.05 | $16.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.53 / $7.84 / $9.80
| Professional | | $6.53 | $7.84 | $9.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.74 / $7.84 / $12.68
| Professional | | $2.74 | $7.84 | $12.68 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.31 / $11.87 / $16.43
| Professional | | $7.31 | $11.87 | $16.43 |