- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.26 / $9.36 / $12.01
| Facility | | $8.26 | $9.36 | $12.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.59 / $11.69 / $44.00
| Professional | | $11.59 | $11.69 | $44.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.85 / $12.01 / $12.01
| Professional | | $7.85 | $12.01 | $12.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.30 / $21.50 / $25.15
| Professional | | $16.30 | $21.50 | $25.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.01 / $12.01 / $15.02
| Professional | | $10.01 | $12.01 | $15.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.20 / $12.01 / $19.44
| Professional | | $4.20 | $12.01 | $19.44 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.21 / $18.20 / $25.20
| Professional | | $11.21 | $18.20 | $25.20 |