- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.39 / $7.24 / $9.28
| Facility | | $6.39 | $7.24 | $9.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.12 / $9.28 / $9.28
| Professional | | $4.12 | $9.28 | $9.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.52 / $11.25 / $13.14
| Professional | | $8.52 | $11.25 | $13.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.74 / $9.28 / $11.61
| Professional | | $7.74 | $9.28 | $11.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.25 / $9.28 / $11.61
| Professional | | $3.25 | $9.28 | $11.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.68 / $9.80 / $13.55
| Professional | | $7.68 | $9.80 | $13.55 |