- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $21.38 / $25.70
| Facility | | $17.78 | $21.38 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $15.85 / $20.89
| Professional | | $8.91 | $15.85 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $9.77 / $25.70
| Professional | | $9.77 | $9.77 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $26.92 / $29.51
| Professional | | $21.88 | $26.92 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $25.70 / $32.36
| Professional | | $21.88 | $25.70 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.12 / $25.70 / $32.36
| Professional | | $9.12 | $25.70 | $32.36 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $29.51 / $44.67
| Professional | | $18.62 | $29.51 | $44.67 |