- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.12 / $10.96 / $13.18
| Facility | | $9.12 | $10.96 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $8.91 / $10.96
| Professional | | $6.03 | $8.91 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $13.18 / $13.18
| Professional | | $13.18 | $13.18 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $16.98 / $19.05
| Professional | | $13.18 | $16.98 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $13.18 / $13.80
| Professional | | $10.96 | $13.18 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.89 / $10.96 / $16.60
| Professional | | $3.89 | $10.96 | $16.60 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $16.22 / $25.70
| Professional | | $13.49 | $16.22 | $25.70 |