- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.32 / $10.00 / $12.30
| Facility | | $8.32 | $10.00 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $8.91 / $8.91
| Professional | | $7.08 | $8.91 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $8.13 / $12.30
| Professional | | $8.13 | $8.13 | $12.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $22.39 / $25.12
| Professional | | $17.38 | $22.39 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $12.30 / $15.14
| Professional | | $10.23 | $12.30 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.27 / $14.13 / $19.95
| Professional | | $4.27 | $14.13 | $19.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $18.20 / $25.70
| Professional | | $11.48 | $18.20 | $25.70 |