- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.73 / $12.16 / $15.61
| Facility | | $10.73 | $12.16 | $15.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.04 / $15.04 / $17.86
| Professional | | $15.04 | $15.04 | $17.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $15.61 / $15.61
| Professional | | $10.40 | $15.61 | $15.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.64 / $20.63 / $24.16
| Professional | | $15.64 | $20.63 | $24.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.01 / $15.61 / $19.52
| Professional | | $13.01 | $15.61 | $19.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.46 / $15.61 / $19.52
| Professional | | $5.46 | $15.61 | $19.52 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.12 / $17.73 / $28.11
| Professional | | $14.12 | $17.73 | $28.11 |