- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.39 / $7.25 / $9.30
| Facility | | $6.39 | $7.25 | $9.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.26 / $9.26 / $9.26
| Professional | | $9.26 | $9.26 | $9.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.09 / $9.30 / $9.30
| Professional | | $6.09 | $9.30 | $9.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.63 / $16.66 / $19.48
| Professional | | $12.63 | $16.66 | $19.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.75 / $9.30 / $11.63
| Professional | | $7.75 | $9.30 | $11.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.26 / $9.30 / $15.03
| Professional | | $3.26 | $9.30 | $15.03 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.68 / $14.08 / $19.48
| Professional | | $8.68 | $14.08 | $19.48 |