- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.66 / $7.55 / $9.68
| Facility | | $6.66 | $7.55 | $9.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.30 / $9.68 / $9.68
| Professional | | $5.30 | $9.68 | $9.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.88 / $14.36 / $16.85
| Professional | | $10.88 | $14.36 | $16.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.07 / $9.68 / $12.11
| Professional | | $8.07 | $9.68 | $12.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $9.68 / $13.00
| Professional | | $3.39 | $9.68 | $13.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.03 / $12.17 / $17.32
| Professional | | $9.03 | $12.17 | $17.32 |