- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.69 / $15.51 / $19.91
| Facility | | $13.69 | $15.51 | $19.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.15 / $19.91 / $19.91
| Professional | | $13.15 | $19.91 | $19.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $35.61 / $41.63
| Professional | | $27.00 | $35.61 | $41.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.59 / $19.91 / $24.89
| Professional | | $16.59 | $19.91 | $24.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.97 / $19.91 / $32.22
| Professional | | $6.97 | $19.91 | $32.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.57 / $30.13 / $41.72
| Professional | | $18.57 | $30.13 | $41.72 |