- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.92 / $8.32 / $10.00
| Facility | | $6.92 | $8.32 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $7.08 / $7.94
| Professional | | $3.98 | $7.08 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.61 / $6.61 / $10.00
| Professional | | $6.61 | $6.61 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $18.62 / $20.42
| Professional | | $14.45 | $18.62 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $10.00 / $12.59
| Professional | | $8.32 | $10.00 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.55 / $11.75 / $16.22
| Professional | | $3.55 | $11.75 | $16.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.33 / $15.14 / $20.89
| Professional | | $9.33 | $15.14 | $20.89 |