- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.15 / $12.64 / $16.22
| Facility | | $11.15 | $12.64 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.87 / $16.22 / $18.91
| Professional | | $14.87 | $16.22 | $18.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $16.22 / $16.22
| Professional | | $10.80 | $16.22 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.96 / $28.96 / $33.95
| Professional | | $21.96 | $28.96 | $33.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.52 / $16.22 / $20.28
| Professional | | $13.52 | $16.22 | $20.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.68 / $16.22 / $26.23
| Professional | | $5.68 | $16.22 | $26.23 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $24.54 / $33.97
| Professional | | $15.14 | $24.54 | $33.97 |