- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.14 / $13.76 / $17.66
| Facility | | $12.14 | $13.76 | $17.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.58 / $17.66 / $17.66
| Professional | | $11.58 | $17.66 | $17.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.94 / $31.57 / $36.92
| Professional | | $23.94 | $31.57 | $36.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.72 / $17.66 / $22.08
| Professional | | $14.72 | $17.66 | $22.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.18 / $17.66 / $28.57
| Professional | | $6.18 | $17.66 | $28.57 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.48 / $26.73 / $37.01
| Professional | | $16.48 | $26.73 | $37.01 |