- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.39 / $12.39 / $12.39
| Professional | | $12.39 | $12.39 | $12.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.54 / $31.54 / $31.54
| Facility | | $31.54 | $31.54 | $31.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.54 / $18.29 / $43.67
| Professional | | $15.54 | $18.29 | $43.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.70 / $41.57 / $41.57
| Professional | | $39.70 | $41.57 | $41.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.82 / $39.70 / $55.58
| Professional | | $23.82 | $39.70 | $55.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.46 / $9.97 / $9.97
| Facility | | $8.46 | $9.97 | $9.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.74 / $31.54 / $43.67
| Professional | | $15.74 | $31.54 | $43.67 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.10 / $33.08 / $37.79
| Professional | | $27.10 | $33.08 | $37.79 |