- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.75 / $14.13 / $16.98
| Facility | | $11.75 | $14.13 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $12.30 / $16.98
| Professional | | $7.08 | $12.30 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $16.98
| Professional | | $11.22 | $11.22 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $34.67 / $34.67
| Professional | | $24.55 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $16.98 / $21.38
| Professional | | $14.13 | $16.98 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.89 / $19.95 / $27.54
| Professional | | $5.89 | $19.95 | $27.54 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $25.70 / $35.48
| Professional | | $15.85 | $25.70 | $35.48 |