- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.13 / $9.21 / $11.82
| Facility | | $8.13 | $9.21 | $11.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.85 / $11.82 / $11.82
| Professional | | $7.85 | $11.82 | $11.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.02 / $21.13 / $24.70
| Professional | | $16.02 | $21.13 | $24.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.85 / $11.82 / $14.78
| Professional | | $9.85 | $11.82 | $14.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.13 / $11.82 / $19.11
| Professional | | $4.13 | $11.82 | $19.11 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.03 / $17.89 / $24.77
| Professional | | $11.03 | $17.89 | $24.77 |