- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.18 / $25.14 / $32.27
| Facility | | $22.18 | $25.14 | $32.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $32.27 / $32.27
| Professional | | $13.55 | $32.27 | $32.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.95 / $36.86 / $43.13
| Professional | | $27.95 | $36.86 | $43.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.89 / $32.27 / $40.34
| Professional | | $26.89 | $32.27 | $40.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.29 / $32.27 / $40.34
| Professional | | $11.29 | $32.27 | $40.34 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.22 / $33.61 / $47.06
| Professional | | $25.22 | $33.61 | $47.06 |