- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.76 / $9.76 / $9.76
| Facility | | $9.76 | $9.76 | $9.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.22 / $8.30 / $13.50
| Professional | | $8.22 | $8.30 | $13.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.76 / $9.76 / $9.76
| Facility | | $9.76 | $9.76 | $9.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.71 / $8.22 / $10.00
| Professional | | $5.71 | $8.22 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.37 / $10.37 / $10.37
| Professional | | $10.37 | $10.37 | $10.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.22 / $9.86 / $12.33
| Professional | | $8.22 | $9.86 | $12.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.16 / $8.50 / $12.33
| Professional | | $8.16 | $8.50 | $12.33 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.20 / $6.37 / $11.68
| Professional | | $4.20 | $6.37 | $11.68 |