- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.19 / $14.95 / $19.19
| Facility | | $13.19 | $14.95 | $19.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.76 / $19.19 / $19.19
| Professional | | $12.76 | $19.19 | $19.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.01 / $34.31 / $40.08
| Professional | | $26.01 | $34.31 | $40.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.99 / $19.19 / $23.99
| Professional | | $15.99 | $19.19 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.72 / $19.19 / $31.04
| Professional | | $6.72 | $19.19 | $31.04 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.91 / $29.03 / $40.19
| Professional | | $17.91 | $29.03 | $40.19 |