- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.71 / $12.14 / $15.58
| Facility | | $10.71 | $12.14 | $15.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.01 / $17.82 / $92.00
| Professional | | $15.01 | $17.82 | $92.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $15.58 / $15.58
| Professional | | $10.21 | $15.58 | $15.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.11 / $27.84 / $32.56
| Professional | | $21.11 | $27.84 | $32.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.98 / $15.58 / $19.47
| Professional | | $12.98 | $15.58 | $19.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.45 / $15.58 / $25.21
| Professional | | $5.45 | $15.58 | $25.21 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.54 / $23.58 / $32.65
| Professional | | $14.54 | $23.58 | $32.65 |