- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.30 / $9.30 / $9.30
| Professional | | $9.30 | $9.30 | $9.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Facility | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.53 / $16.53 / $29.60
| Professional | | $16.53 | $16.53 | $29.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.91 / $28.18 / $28.18
| Professional | | $26.91 | $28.18 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.14 / $26.91 / $37.67
| Professional | | $16.14 | $26.91 | $37.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.31 / $8.61 / $8.61
| Facility | | $7.31 | $8.61 | $8.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.66 / $25.16 / $29.60
| Professional | | $11.66 | $25.16 | $29.60 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.37 / $22.42 / $25.61
| Professional | | $18.37 | $22.42 | $25.61 |