- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $13.62 / $17.48
| Facility | | $12.02 | $13.62 | $17.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.58 / $17.48 / $17.48
| Professional | | $11.58 | $17.48 | $17.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $31.20 / $36.51
| Professional | | $23.65 | $31.20 | $36.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.57 / $17.48 / $21.86
| Professional | | $14.57 | $17.48 | $21.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.12 / $17.48 / $28.27
| Professional | | $6.12 | $17.48 | $28.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.32 / $26.44 / $36.61
| Professional | | $16.32 | $26.44 | $36.61 |