- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.21 / $54.71 / $95.07
| Professional | | $34.21 | $54.71 | $95.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.30 / $73.30 / $87.96
| Professional | | $54.30 | $73.30 | $87.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.94 / $62.85 / $82.51
| Professional | | $53.94 | $62.85 | $82.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.34 / $62.16 / $73.30
| Professional | | $38.34 | $62.16 | $73.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.37 / $71.95 / $85.11
| Professional | | $52.37 | $71.95 | $85.11 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $45.67 / $73.37
| Professional | | $29.27 | $45.67 | $73.37 |