- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.37 / $25.35 / $32.53
| Facility | | $22.37 | $25.35 | $32.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $32.53 / $32.53
| Professional | | $13.55 | $32.53 | $32.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.36 / $38.72 / $43.07
| Professional | | $29.36 | $38.72 | $43.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.11 / $32.53 / $40.67
| Professional | | $27.11 | $32.53 | $40.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $32.53 / $40.67
| Professional | | $11.39 | $32.53 | $40.67 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.04 / $36.60 / $60.27
| Professional | | $23.04 | $36.60 | $60.27 |