- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.62 / $17.70 / $22.72
| Facility | | $15.62 | $17.70 | $22.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.12 / $22.72 / $22.72
| Professional | | $15.12 | $22.72 | $22.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.82 / $40.65 / $47.55
| Professional | | $30.82 | $40.65 | $47.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.93 / $22.72 / $28.40
| Professional | | $18.93 | $22.72 | $28.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.95 / $22.72 / $36.77
| Professional | | $7.95 | $22.72 | $36.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.20 / $34.40 / $47.63
| Professional | | $21.20 | $34.40 | $47.63 |