- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.07 / $34.07 / $34.07
| Professional | | $34.07 | $34.07 | $34.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.41 / $55.41 / $55.41
| Facility | | $55.41 | $55.41 | $55.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.70 / $49.30 / $76.73
| Professional | | $37.70 | $49.30 | $76.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.75 / $73.04 / $73.04
| Professional | | $69.75 | $73.04 | $73.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.61 / $69.75 / $97.65
| Professional | | $47.61 | $69.75 | $97.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.42 / $55.41 / $76.73
| Professional | | $42.42 | $55.41 | $76.73 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.19 / $58.12 / $66.39
| Professional | | $56.19 | $58.12 | $66.39 |