- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.32 / $8.28 / $10.64
| Facility | | $7.32 | $8.28 | $10.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.07 / $10.64 / $10.64
| Professional | | $7.07 | $10.64 | $10.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.42 / $19.02 / $22.27
| Professional | | $14.42 | $19.02 | $22.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.86 / $10.64 / $13.31
| Professional | | $8.86 | $10.64 | $13.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.73 / $10.64 / $17.23
| Professional | | $3.73 | $10.64 | $17.23 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.93 / $16.12 / $22.32
| Professional | | $9.93 | $16.12 | $22.32 |