- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $13.49 / $18.62
| Facility | | $11.22 | $13.49 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $12.30 / $16.60
| Professional | | $10.00 | $12.30 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $10.72 / $16.60
| Professional | | $10.72 | $10.72 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $30.20 / $33.88
| Professional | | $23.44 | $30.20 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $16.60 / $25.70
| Professional | | $13.80 | $16.60 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $19.05 / $26.92
| Professional | | $5.75 | $19.05 | $26.92 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $24.55 / $34.67
| Professional | | $15.49 | $24.55 | $34.67 |