- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.38 / $25.38 / $25.38
| Facility | | $25.38 | $25.38 | $25.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.37 / $25.37 / $25.37
| Facility | | $25.37 | $25.37 | $25.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.54 / $16.54 / $16.54
| Professional | | $16.54 | $16.54 | $16.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.23 / $20.23 / $20.23
| Professional | | $20.23 | $20.23 | $20.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $19.85 / $23.16
| Professional | | $18.20 | $19.85 | $23.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.54 / $16.64 / $24.81
| Professional | | $16.54 | $16.64 | $24.81 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.09 / $16.77 / $21.05
| Professional | | $12.09 | $16.77 | $21.05 |