- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.08 / $6.08 / $6.08
| Professional | | $6.08 | $6.08 | $6.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.67 / $10.67 / $10.67
| Facility | | $10.67 | $10.67 | $10.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.85 / $8.81 / $14.76
| Professional | | $5.85 | $8.81 | $14.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.42 / $14.05 / $14.05
| Professional | | $13.42 | $14.05 | $14.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.05 / $13.42 / $18.79
| Professional | | $8.05 | $13.42 | $18.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.57 / $10.67 / $14.76
| Professional | | $7.57 | $10.67 | $14.76 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.18 / $11.19 / $12.78
| Professional | | $9.18 | $11.19 | $12.78 |