- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.68 / $27.98 / $35.90
| Facility | | $24.68 | $27.98 | $35.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.46 / $21.46 / $21.46
| Professional | | $21.46 | $21.46 | $21.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.42 / $35.90 / $35.90
| Professional | | $27.42 | $35.90 | $35.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.25 / $43.29 / $56.27
| Professional | | $32.25 | $43.29 | $56.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.92 / $35.90 / $44.88
| Professional | | $29.92 | $35.90 | $44.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.57 / $35.90 / $44.88
| Professional | | $12.57 | $35.90 | $44.88 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.89 / $41.28 / $57.94
| Professional | | $32.89 | $41.28 | $57.94 |