- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.16 / $6.98 / $8.96
| Facility | | $6.16 | $6.98 | $8.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.30 / $8.96 / $8.96
| Professional | | $5.30 | $8.96 | $8.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.88 / $14.36 / $16.79
| Professional | | $10.88 | $14.36 | $16.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.47 / $8.96 / $11.21
| Professional | | $7.47 | $8.96 | $11.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.14 / $8.96 / $12.97
| Professional | | $3.14 | $8.96 | $12.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.36 / $12.05 / $16.80
| Professional | | $8.36 | $12.05 | $16.80 |