- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.48 / $7.35 / $9.43
| Facility | | $6.48 | $7.35 | $9.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.65 / $9.43 / $10.79
| Professional | | $8.65 | $9.43 | $10.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.28 / $9.43 / $9.43
| Professional | | $6.28 | $9.43 | $9.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.77 / $16.85 / $19.76
| Professional | | $12.77 | $16.85 | $19.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.86 / $9.43 / $11.79
| Professional | | $7.86 | $9.43 | $11.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.30 / $9.43 / $15.26
| Professional | | $3.30 | $9.43 | $15.26 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.80 / $14.27 / $19.76
| Professional | | $8.80 | $14.27 | $19.76 |