- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.37 / $8.35 / $10.72
| Facility | | $7.37 | $8.35 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.73 / $4.73 / $8.92
| Professional | | $4.73 | $4.73 | $8.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.07 / $10.72 / $10.72
| Professional | | $7.07 | $10.72 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.52 / $19.14 / $22.40
| Professional | | $14.52 | $19.14 | $22.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.93 / $10.72 / $13.40
| Professional | | $8.93 | $10.72 | $13.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.75 / $10.72 / $17.34
| Professional | | $3.75 | $10.72 | $17.34 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $16.22 / $22.46
| Professional | | $10.00 | $16.22 | $22.46 |