- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.70 / $30.90 / $37.15
| Facility | | $25.70 | $30.90 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $25.70 / $38.90
| Professional | | $14.13 | $25.70 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $15.85 / $37.15
| Professional | | $14.13 | $15.85 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $44.67 / $48.98
| Professional | | $34.67 | $44.67 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $37.15 / $46.77
| Professional | | $34.67 | $37.15 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $28.18 / $46.77
| Professional | | $14.13 | $28.18 | $46.77 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $38.90 / $54.95
| Professional | | $29.51 | $38.90 | $54.95 |