- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.47 / $17.53 / $22.50
| Facility | | $15.47 | $17.53 | $22.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.92 / $22.50 / $22.50
| Professional | | $14.92 | $22.50 | $22.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.48 / $40.22 / $47.09
| Professional | | $30.48 | $40.22 | $47.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.75 / $22.50 / $28.13
| Professional | | $18.75 | $22.50 | $28.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.88 / $22.50 / $36.39
| Professional | | $7.88 | $22.50 | $36.39 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.00 / $34.07 / $47.18
| Professional | | $21.00 | $34.07 | $47.18 |