- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.51 / $15.32 / $19.66
| Facility | | $13.51 | $15.32 | $19.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.14 / $19.14 / $19.14
| Professional | | $19.14 | $19.14 | $19.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.96 / $19.66 / $19.66
| Professional | | $12.96 | $19.66 | $19.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.67 / $35.18 / $41.13
| Professional | | $26.67 | $35.18 | $41.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.38 / $19.66 / $24.57
| Professional | | $16.38 | $19.66 | $24.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.88 / $19.66 / $31.81
| Professional | | $6.88 | $19.66 | $31.81 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.35 / $29.77 / $41.22
| Professional | | $18.35 | $29.77 | $41.22 |