- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.08 / $13.08 / $13.08
| Facility | | $13.08 | $13.08 | $13.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.53 / $14.51 / $29.82
| Professional | | $6.53 | $14.51 | $29.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.07 / $13.07 / $13.07
| Facility | | $13.07 | $13.07 | $13.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $7.08 / $7.08
| Professional | | $7.08 | $7.08 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.79 / $10.79 / $10.79
| Professional | | $10.79 | $10.79 | $10.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.79 / $8.50 / $9.91
| Professional | | $7.79 | $8.50 | $9.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $8.86 / $10.62
| Professional | | $7.08 | $8.86 | $10.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.27 / $7.98 / $11.92
| Professional | | $5.27 | $7.98 | $11.92 |