- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.16 / $9.25 / $11.87
| Facility | | $8.16 | $9.25 | $11.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.88 / $10.88 / $11.28
| Professional | | $10.88 | $10.88 | $11.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.46 / $11.87 / $11.87
| Professional | | $7.46 | $11.87 | $11.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.44 / $16.41 / $23.64
| Professional | | $12.44 | $16.41 | $23.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.89 / $11.87 / $14.84
| Professional | | $9.89 | $11.87 | $14.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.15 / $11.87 / $18.32
| Professional | | $4.15 | $11.87 | $18.32 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.15 / $17.00 / $23.72
| Professional | | $8.15 | $17.00 | $23.72 |