- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.30 / $8.27 / $10.62
| Facility | | $7.30 | $8.27 | $10.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.07 / $10.62 / $10.62
| Professional | | $7.07 | $10.62 | $10.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.37 / $18.96 / $22.18
| Professional | | $14.37 | $18.96 | $22.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.85 / $10.62 / $13.28
| Professional | | $8.85 | $10.62 | $13.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $10.62 / $17.17
| Professional | | $3.72 | $10.62 | $17.17 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.91 / $16.07 / $22.25
| Professional | | $9.91 | $16.07 | $22.25 |