- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.11 / $9.19 / $11.81
| Facility | | $8.11 | $9.19 | $11.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.07 / $7.07 / $7.07
| Professional | | $7.07 | $7.07 | $7.07 |
- 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
- $9.84 / $11.81 / $14.76
| Professional | | $9.84 | $11.81 | $14.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.90 / $11.81 / $17.32
| Professional | | $5.90 | $11.81 | $17.32 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.71 / $17.71 / $21.79
| Professional | | $17.71 | $17.71 | $21.79 |