- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $15.85 / $23.99
| Professional | | $12.88 | $15.85 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $18.20 / $26.30
| Professional | | $13.18 | $18.20 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $26.30 / $29.51
| Professional | | $22.91 | $26.30 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $27.54 / $38.02
| Professional | | $27.54 | $27.54 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $22.39 / $26.92
| Professional | | $10.72 | $22.39 | $26.92 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $25.12 / $39.81
| Professional | | $15.49 | $25.12 | $39.81 |