- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.51 / $26.65 / $34.20
| Facility | | $23.51 | $26.65 | $34.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.81 / $34.20 / $34.20
| Professional | | $20.81 | $34.20 | $34.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.79 / $56.43 / $66.05
| Professional | | $42.79 | $56.43 | $66.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.50 / $34.20 / $42.75
| Professional | | $28.50 | $34.20 | $42.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.97 / $34.20 / $51.04
| Professional | | $11.97 | $34.20 | $51.04 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.92 / $47.78 / $66.15
| Professional | | $31.92 | $47.78 | $66.15 |