- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.37 / $15.15 / $19.44
| Facility | | $13.37 | $15.15 | $19.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $19.44 / $19.44
| Professional | | $10.40 | $19.44 | $19.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.44 / $28.28 / $33.09
| Professional | | $21.44 | $28.28 | $33.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.20 / $19.44 / $24.30
| Professional | | $16.20 | $19.44 | $24.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.80 / $19.44 / $25.61
| Professional | | $6.80 | $19.44 | $25.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.14 / $23.96 / $34.10
| Professional | | $18.14 | $23.96 | $34.10 |