- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.41 / $16.10 / $19.51
| Facility | | $13.41 | $16.10 | $19.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.49 / $14.49 / $22.32
| Professional | | $14.49 | $14.49 | $22.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.96 / $19.51 / $19.51
| Professional | | $12.96 | $19.51 | $19.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.43 / $34.86 / $40.83
| Professional | | $26.43 | $34.86 | $40.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.26 / $19.51 / $24.39
| Professional | | $16.26 | $19.51 | $24.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.83 / $19.51 / $31.55
| Professional | | $6.83 | $19.51 | $31.55 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.21 / $29.54 / $40.90
| Professional | | $18.21 | $29.54 | $40.90 |