- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.26 / $9.26 / $9.26
| Professional | | $9.26 | $9.26 | $9.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.41 / $24.41 / $24.41
| Facility | | $24.41 | $24.41 | $24.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.44 / $14.44 / $33.79
| Professional | | $14.44 | $14.44 | $33.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.73 / $32.18 / $32.18
| Professional | | $30.73 | $32.18 | $32.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.44 / $30.73 / $43.02
| Professional | | $18.44 | $30.73 | $43.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.42 / $24.41 / $33.79
| Professional | | $14.42 | $24.41 | $33.79 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.44 / $19.20 / $29.25
| Professional | | $13.44 | $19.20 | $29.25 |