- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.76 / $7.66 / $9.83
| Facility | | $6.76 | $7.66 | $9.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $9.83 / $9.83
| Professional | | $6.48 | $9.83 | $9.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.34 / $17.59 / $20.54
| Professional | | $13.34 | $17.59 | $20.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.19 / $9.83 / $12.29
| Professional | | $8.19 | $9.83 | $12.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.83 / $9.83 / $12.29
| Professional | | $9.83 | $9.83 | $12.29 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.17 / $14.87 / $20.59
| Professional | | $9.17 | $14.87 | $20.59 |