- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.79 / $14.49 / $18.60
| Facility | | $12.79 | $14.49 | $18.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.37 / $18.60 / $18.60
| Professional | | $12.37 | $18.60 | $18.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.21 / $33.26 / $38.88
| Professional | | $25.21 | $33.26 | $38.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.50 / $18.60 / $23.25
| Professional | | $15.50 | $18.60 | $23.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.51 / $18.60 / $30.08
| Professional | | $6.51 | $18.60 | $30.08 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.36 / $28.16 / $38.99
| Professional | | $17.36 | $28.16 | $38.99 |