- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $6.03 / $7.94
| Professional | | $5.01 | $6.03 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $7.41 / $9.12
| Professional | | $7.08 | $7.41 | $9.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $8.91 / $11.22
| Professional | | $7.41 | $8.91 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.12 / $10.72 / $12.59
| Professional | | $9.12 | $10.72 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $7.94 / $12.59
| Professional | | $6.31 | $7.94 | $12.59 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.37 / $7.76 / $15.85
| Professional | | $5.37 | $7.76 | $15.85 |