- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.26 / $15.03 / $19.28
| Facility | | $13.26 | $15.03 | $19.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $10.74 / $22.06
| Professional | | $10.74 | $10.74 | $22.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $19.28 / $19.28
| Professional | | $9.42 | $19.28 | $19.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.51 / $25.73 / $30.11
| Professional | | $19.51 | $25.73 | $30.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.07 / $19.28 / $24.11
| Professional | | $16.07 | $19.28 | $24.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.75 / $19.28 / $24.11
| Professional | | $6.75 | $19.28 | $24.11 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.60 / $21.79 / $31.01
| Professional | | $17.60 | $21.79 | $31.01 |