- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.45 / $7.31 / $9.38
| Facility | | $6.45 | $7.31 | $9.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $9.38 / $9.38
| Professional | | $4.12 | $9.38 | $9.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.48 / $11.19 / $13.14
| Professional | | $8.48 | $11.19 | $13.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.82 / $9.38 / $11.73
| Professional | | $7.82 | $9.38 | $11.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.28 / $9.38 / $11.73
| Professional | | $3.28 | $9.38 | $11.73 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.67 / $9.77 / $13.69
| Professional | | $7.67 | $9.77 | $13.69 |