- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.71 / $8.74 / $11.22
| Facility | | $7.71 | $8.74 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $12.84 / $60.12
| Professional | | $7.94 | $12.84 | $60.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $11.22 / $11.22
| Professional | | $5.50 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.17 / $14.74 / $17.23
| Professional | | $11.17 | $14.74 | $17.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.35 / $11.22 / $14.03
| Professional | | $9.35 | $11.22 | $14.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.93 / $11.22 / $14.03
| Professional | | $3.93 | $11.22 | $14.03 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.09 / $12.65 / $17.78
| Professional | | $10.09 | $12.65 | $17.78 |