- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.86 / $10.03 / $12.89
| Facility | | $8.86 | $10.03 | $12.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $12.89 / $12.89
| Professional | | $6.48 | $12.89 | $12.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.47 / $17.77 / $20.75
| Professional | | $13.47 | $17.77 | $20.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $12.89 / $16.11
| Professional | | $10.74 | $12.89 | $16.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.51 / $12.89 / $16.11
| Professional | | $4.51 | $12.89 | $16.11 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.03 / $15.22 / $21.39
| Professional | | $12.03 | $15.22 | $21.39 |