- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.77 / $9.94 / $12.76
| Facility | | $8.77 | $9.94 | $12.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.25 / $12.76 / $12.76
| Professional | | $8.25 | $12.76 | $12.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.92 / $22.32 / $26.09
| Professional | | $16.92 | $22.32 | $26.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.63 / $12.76 / $15.95
| Professional | | $10.63 | $12.76 | $15.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.76 / $12.76 / $15.95
| Professional | | $12.76 | $12.76 | $15.95 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.91 / $18.89 / $26.15
| Professional | | $11.91 | $18.89 | $26.15 |