- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.93 / $13.52 / $17.35
| Facility | | $11.93 | $13.52 | $17.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.67 / $17.35 / $17.35
| Professional | | $6.67 | $17.35 | $17.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.81 / $18.22 / $21.34
| Professional | | $13.81 | $18.22 | $21.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.46 / $17.35 / $21.69
| Professional | | $14.46 | $17.35 | $21.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.07 / $17.35 / $21.69
| Professional | | $6.07 | $17.35 | $21.69 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.46 / $17.05 / $25.31
| Professional | | $12.46 | $17.05 | $25.31 |