- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.73 / $16.73 / $16.73
| Facility | | $16.73 | $16.73 | $16.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.52 / $8.63 / $11.72
| Professional | | $8.52 | $8.63 | $11.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.73 / $16.73 / $16.73
| Facility | | $16.73 | $16.73 | $16.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.53 / $8.53 / $8.53
| Professional | | $8.53 | $8.53 | $8.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.64 / $24.64 / $24.64
| Professional | | $24.64 | $24.64 | $24.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.40 / $10.25 / $11.96
| Professional | | $9.40 | $10.25 | $11.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.75 / $9.51 / $12.81
| Professional | | $7.75 | $9.51 | $12.81 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.53 / $10.31 / $15.16
| Professional | | $7.53 | $10.31 | $15.16 |