- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.55 / $29.51 / $36.31
| Facility | | $24.55 | $29.51 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $42.66 / $67.61
| Professional | | $30.20 | $42.66 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $9.55 / $36.31
| Professional | | $9.55 | $9.55 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $37.15 / $41.69
| Professional | | $30.20 | $37.15 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $36.31 / $44.67
| Professional | | $30.20 | $36.31 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $23.44 / $44.67
| Professional | | $12.59 | $23.44 | $44.67 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $26.30 / $46.77
| Professional | | $18.62 | $26.30 | $46.77 |