- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.21 / $31.97 / $41.03
| Facility | | $28.21 | $31.97 | $41.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.04 / $41.03 / $41.03
| Professional | | $19.04 | $41.03 | $41.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.06 / $61.02 / $74.25
| Professional | | $48.06 | $61.02 | $74.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.19 / $41.03 / $51.29
| Professional | | $34.19 | $41.03 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.36 / $41.03 / $51.29
| Professional | | $14.36 | $41.03 | $51.29 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.06 / $46.16 / $76.93
| Professional | | $29.06 | $46.16 | $76.93 |