- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $24.55 / $24.55
| Professional | | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.47 / $53.47 / $53.47
| Facility | | $53.47 | $53.47 | $53.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.45 / $74.05 / $74.05
| Professional | | $46.45 | $74.05 | $74.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.31 / $70.48 / $70.48
| Professional | | $67.31 | $70.48 | $70.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.39 / $67.31 / $94.25
| Professional | | $40.39 | $67.31 | $94.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.91 / $59.97 / $74.05
| Professional | | $46.91 | $59.97 | $74.05 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.44 / $54.22 / $64.06
| Professional | | $29.44 | $54.22 | $64.06 |