- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.88 / $11.20 / $14.38
| Facility | | $9.88 | $11.20 | $14.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.71 / $14.38 / $23.96
| Professional | | $10.71 | $14.38 | $23.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $9.42 / $9.42
| Professional | | $9.42 | $9.42 | $9.42 |
- 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
- $11.98 / $14.38 / $16.98
| Professional | | $11.98 | $14.38 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.03 / $14.38 / $23.27
| Professional | | $5.03 | $14.38 | $23.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.60 / $20.73 / $23.21
| Professional | | $17.60 | $20.73 | $23.21 |