- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.97 / $11.30 / $14.51
| Facility | | $9.97 | $11.30 | $14.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.78 / $10.97 / $16.60
| Professional | | $10.78 | $10.97 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.51 / $14.51 / $14.51
| Professional | | $14.51 | $14.51 | $14.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.55 / $23.56 / $28.68
| Professional | | $18.55 | $23.56 | $28.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.09 / $14.51 / $18.14
| Professional | | $12.09 | $14.51 | $18.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.08 / $14.51 / $18.14
| Professional | | $5.08 | $14.51 | $18.14 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.28 / $16.20 / $27.20
| Professional | | $10.28 | $16.20 | $27.20 |