- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.94 / $9.55 / $11.75
| Facility | | $7.94 | $9.55 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $7.08 / $8.91
| Professional | | $5.01 | $7.08 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $5.75 / $11.75
| Professional | | $5.75 | $5.75 | $11.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $15.85 / $17.38
| Professional | | $12.30 | $15.85 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $11.75 / $14.45
| Professional | | $9.77 | $11.75 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.07 / $11.75 / $14.45
| Professional | | $4.07 | $11.75 | $14.45 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $13.18 / $18.62
| Professional | | $9.77 | $13.18 | $18.62 |