- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.66 / $16.61 / $21.32
| Facility | | $14.66 | $16.61 | $21.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.98 / $21.32 / $21.32
| Professional | | $11.98 | $21.32 | $21.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.51 / $32.32 / $37.85
| Professional | | $24.51 | $32.32 | $37.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.77 / $21.32 / $26.66
| Professional | | $17.77 | $21.32 | $26.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.46 / $21.32 / $29.27
| Professional | | $7.46 | $21.32 | $29.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.89 / $27.38 / $38.96
| Professional | | $19.89 | $27.38 | $38.96 |