- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.10 / $8.03 / $10.32
| Facility | | $7.10 | $8.03 | $10.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.87 / $10.32 / $10.32
| Professional | | $6.87 | $10.32 | $10.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.00 / $18.46 / $21.57
| Professional | | $14.00 | $18.46 | $21.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.60 / $10.32 / $12.90
| Professional | | $8.60 | $10.32 | $12.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.61 / $10.32 / $16.70
| Professional | | $3.61 | $10.32 | $16.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.63 / $15.63 / $21.64
| Professional | | $9.63 | $15.63 | $21.64 |