- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.09 / $9.86 / $14.40
| Professional | | $5.09 | $9.86 | $14.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.99 / $9.42 / $13.14
| Professional | | $6.99 | $9.42 | $13.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.78 / $7.70 / $9.05
| Professional | | $6.78 | $7.70 | $9.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.59 / $10.02 / $10.90
| Professional | | $9.59 | $10.02 | $10.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.88 / $8.30 / $13.38
| Professional | | $6.88 | $8.30 | $13.38 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.62 / $11.24 / $250.00
| Professional | | $7.62 | $11.24 | $250.00 |