- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.39 / $20.88 / $25.31
| Facility | | $17.39 | $20.88 | $25.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.77 / $15.13 / $17.29
| Professional | | $13.77 | $15.13 | $17.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.37 / $25.31 / $25.31
| Professional | | $12.37 | $25.31 | $25.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.21 / $33.26 / $38.88
| Professional | | $25.21 | $33.26 | $38.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.09 / $25.31 / $31.64
| Professional | | $21.09 | $25.31 | $31.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.86 / $25.31 / $31.64
| Professional | | $8.86 | $25.31 | $31.64 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.09 / $30.79 / $47.45
| Professional | | $21.09 | $30.79 | $47.45 |