- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.90 / $8.96 / $11.50
| Facility | | $7.90 | $8.96 | $11.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.55 / $8.55 / $13.15
| Professional | | $8.55 | $8.55 | $13.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.66 / $11.50 / $11.50
| Professional | | $7.66 | $11.50 | $11.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.55 / $20.51 / $24.04
| Professional | | $15.55 | $20.51 | $24.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.58 / $11.50 / $14.37
| Professional | | $9.58 | $11.50 | $14.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.01 / $11.50 / $18.60
| Professional | | $4.01 | $11.50 | $18.60 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.73 / $17.38 / $24.07
| Professional | | $10.73 | $17.38 | $24.07 |