- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.78 / $12.22 / $15.68
| Facility | | $10.78 | $12.22 | $15.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.30 / $7.82 / $17.94
| Professional | | $5.30 | $7.82 | $17.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.05 / $15.68 / $15.68
| Professional | | $8.05 | $15.68 | $15.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.64 / $11.64 / $13.69
| Professional | | $9.64 | $11.64 | $13.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.38 / $15.68 / $18.30
| Professional | | $14.38 | $15.68 | $18.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $15.68 / $19.61
| Professional | | $8.71 | $15.68 | $19.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.82 / $10.35 / $19.21
| Professional | | $6.82 | $10.35 | $19.21 |