- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.69 / $21.18 / $27.18
| Facility | | $18.69 | $21.18 | $27.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.86 / $27.18 / $27.18
| Professional | | $17.86 | $27.18 | $27.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.85 / $48.60 / $56.87
| Professional | | $36.85 | $48.60 | $56.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.65 / $27.18 / $33.97
| Professional | | $22.65 | $27.18 | $33.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.18 / $27.18 / $33.97
| Professional | | $27.18 | $27.18 | $33.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.37 / $41.15 / $56.97
| Professional | | $25.37 | $41.15 | $56.97 |