- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $300.00 / $300.00
| Facility | | $300.00 | $300.00 | $300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.50 / $42.00 / $300.00
| Professional | | $32.50 | $42.00 | $300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.00 / $225.00 / $270.00
| Professional | | $165.00 | $225.00 | $270.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.06 / $140.00 / $262.39
| Professional | | $89.06 | $140.00 | $262.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $64.00 / $77.00
| Professional | | $30.00 | $64.00 | $77.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.69 / $49.30 / $71.83
| Professional | | $8.69 | $49.30 | $71.83 |