- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.05 / $16.86 / $20.44
| Facility | | $14.05 | $16.86 | $20.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.48 / $14.74 / $15.17
| Professional | | $14.48 | $14.74 | $15.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $13.55 / $13.55
| Professional | | $13.55 | $13.55 | $13.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.71 / $36.54 / $42.76
| Professional | | $27.71 | $36.54 | $42.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.03 / $20.44 / $25.55
| Professional | | $17.03 | $20.44 | $25.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.15 / $20.44 / $33.06
| Professional | | $7.15 | $20.44 | $33.06 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.99 / $29.43 / $33.85
| Professional | | $24.99 | $29.43 | $33.85 |