- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.72 / $12.72 / $12.72
| Professional | | $12.72 | $12.72 | $12.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.67 / $29.67 / $29.67
| Facility | | $29.67 | $29.67 | $29.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $41.10
| Professional | | $21.38 | $21.38 | $41.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.36 / $39.11 / $39.11
| Professional | | $37.36 | $39.11 | $39.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.42 / $37.36 / $52.30
| Professional | | $22.42 | $37.36 | $52.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.05 / $29.67 / $41.10
| Professional | | $20.05 | $29.67 | $41.10 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.09 / $31.12 / $35.56
| Professional | | $30.09 | $31.12 | $35.56 |