- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.08 / $6.89 / $8.84
| Facility | | $6.08 | $6.89 | $8.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.89 / $8.84 / $8.84
| Professional | | $5.89 | $8.84 | $8.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.97 / $15.79 / $18.48
| Professional | | $11.97 | $15.79 | $18.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.37 / $8.84 / $11.06
| Professional | | $7.37 | $8.84 | $11.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.10 / $8.84 / $14.31
| Professional | | $3.10 | $8.84 | $14.31 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.25 / $13.39 / $18.54
| Professional | | $8.25 | $13.39 | $18.54 |