- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.96 / $39.63 / $50.86
| Facility | | $34.96 | $39.63 | $50.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.93 / $26.93 / $26.93
| Professional | | $26.93 | $26.93 | $26.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.68 / $50.86 / $50.86
| Professional | | $27.68 | $50.86 | $50.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.05 / $70.86 / $82.58
| Professional | | $60.05 | $70.86 | $82.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.62 / $50.86 / $59.33
| Professional | | $46.62 | $50.86 | $59.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.86 / $62.91 / $67.56
| Professional | | $50.86 | $62.91 | $67.56 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.47 / $62.73 / $89.97
| Professional | | $47.47 | $62.73 | $89.97 |