- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.30 / $17.30 / $17.30
| Professional | | $17.30 | $17.30 | $17.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.39 / $40.39 / $40.39
| Facility | | $40.39 | $40.39 | $40.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.33 / $55.92 / $55.92
| Professional | | $36.33 | $55.92 | $55.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.84 / $53.24 / $53.24
| Professional | | $50.84 | $53.24 | $53.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.50 / $50.84 / $71.18
| Professional | | $30.50 | $50.84 | $71.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.01 / $23.01 / $29.72
| Facility | | $23.01 | $23.01 | $29.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.26 / $40.39 / $55.92
| Professional | | $27.26 | $40.39 | $55.92 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.96 / $42.36 / $48.39
| Professional | | $40.96 | $42.36 | $48.39 |