- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.56 / $9.71 / $12.46
| Facility | | $8.56 | $9.71 | $12.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.85 / $12.46 / $12.46
| Professional | | $7.85 | $12.46 | $12.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.12 / $21.26 / $24.81
| Professional | | $16.12 | $21.26 | $24.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.38 / $12.46 / $15.57
| Professional | | $10.38 | $12.46 | $15.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.36 / $12.46 / $19.21
| Professional | | $4.36 | $12.46 | $19.21 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.82 / $15.26 / $24.20
| Professional | | $8.82 | $15.26 | $24.20 |