- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.64 / $13.64 / $13.64
| Facility | | $13.64 | $13.64 | $13.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.33 / $10.43 / $16.05
| Professional | | $10.33 | $10.43 | $16.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.64 / $13.64 / $13.64
| Facility | | $13.64 | $13.64 | $13.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.34 / $10.34 / $10.34
| Professional | | $10.34 | $10.34 | $10.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.55 / $7.55 / $7.55
| Professional | | $7.55 | $7.55 | $7.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.38 / $12.41 / $14.48
| Professional | | $11.38 | $12.41 | $14.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.20 / $10.34 / $15.51
| Professional | | $6.20 | $10.34 | $15.51 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.83 / $9.00 / $16.36
| Professional | | $3.83 | $9.00 | $16.36 |