- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.68 / $6.43 / $8.26
| Facility | | $5.68 | $6.43 | $8.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.09 / $8.26 / $8.26
| Professional | | $5.09 | $8.26 | $8.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.51 / $13.87 / $16.25
| Professional | | $10.51 | $13.87 | $16.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.88 / $8.26 / $10.32
| Professional | | $6.88 | $8.26 | $10.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.89 / $8.26 / $12.55
| Professional | | $2.89 | $8.26 | $12.55 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.71 / $11.75 / $16.27
| Professional | | $7.71 | $11.75 | $16.27 |