- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.36 / $7.36 / $7.36
| Professional | | $7.36 | $7.36 | $7.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Facility | | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.65 / $10.65 / $15.53
| Professional | | $10.65 | $10.65 | $15.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.12 / $14.79 / $14.79
| Professional | | $14.12 | $14.79 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.36 / $14.12 / $19.77
| Professional | | $9.36 | $14.12 | $19.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.51 / $11.22 / $15.53
| Professional | | $7.51 | $11.22 | $15.53 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.63 / $11.76 / $13.44
| Professional | | $9.63 | $11.76 | $13.44 |