- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.10 / $8.05 / $10.33
| Facility | | $7.10 | $8.05 | $10.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.94 / $11.82 / $64.00
| Professional | | $9.94 | $11.82 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.87 / $10.33 / $10.33
| Professional | | $6.87 | $10.33 | $10.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.00 / $18.46 / $21.57
| Professional | | $14.00 | $18.46 | $21.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.61 / $10.33 / $12.92
| Professional | | $8.61 | $10.33 | $12.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.17 / $10.33 / $16.72
| Professional | | $5.17 | $10.33 | $16.72 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.32 / $12.66 / $21.05
| Professional | | $7.32 | $12.66 | $21.05 |