- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.72 / $32.54 / $41.77
| Facility | | $28.72 | $32.54 | $41.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.40 / $22.40 / $22.40
| Professional | | $22.40 | $22.40 | $22.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.52 / $41.77 / $41.77
| Professional | | $25.52 | $41.77 | $41.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.45 / $65.43 / $76.25
| Professional | | $55.45 | $65.43 | $76.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.29 / $41.77 / $48.73
| Professional | | $38.29 | $41.77 | $48.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.77 / $52.22 / $62.37
| Professional | | $41.77 | $52.22 | $62.37 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.99 / $57.91 / $80.80
| Professional | | $38.99 | $57.91 | $80.80 |