- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.62 / $18.84 / $24.18
| Facility | | $16.62 | $18.84 | $24.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.74 / $24.18 / $24.18
| Professional | | $13.74 | $24.18 | $24.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.06 / $39.65 / $44.14
| Professional | | $30.06 | $39.65 | $44.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.14 / $24.18 / $30.23
| Professional | | $20.14 | $24.18 | $30.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.46 / $24.18 / $35.90
| Professional | | $8.46 | $24.18 | $35.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.13 / $27.75 / $45.34
| Professional | | $17.13 | $27.75 | $45.34 |