- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.02 / $117.14 / $117.14
| Facility | | $21.02 | $117.14 | $117.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.38 / $30.87 / $49.46
| Professional | | $19.38 | $30.87 | $49.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.15 / $13.15 / $13.15
| Professional | | $13.15 | $13.15 | $13.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.72 / $32.65 / $39.74
| Professional | | $25.72 | $32.65 | $39.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.48 / $26.98 / $33.72
| Professional | | $22.48 | $26.98 | $33.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $26.98 / $33.72
| Professional | | $13.49 | $26.98 | $33.72 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.42 / $36.77 / $46.80
| Professional | | $30.42 | $36.77 | $46.80 |