- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.90 / $18.89 / $18.89
| Professional | | $12.90 | $18.89 | $18.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.07 / $16.92 / $21.00
| Professional | | $16.07 | $16.92 | $21.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.13 / $19.53 / $21.48
| Professional | | $6.13 | $19.53 | $21.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.40 / $16.80 / $19.60
| Professional | | $15.40 | $16.80 | $19.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.66 / $18.89 / $22.87
| Professional | | $7.66 | $18.89 | $22.87 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.50 / $20.95 / $37.67
| Professional | | $15.50 | $20.95 | $37.67 |