- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.89 / $25.12 / $30.90
| Facility | | $20.89 | $25.12 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $22.91 / $23.99
| Professional | | $18.20 | $22.91 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $19.95 / $30.90
| Professional | | $19.95 | $19.95 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $61.66 / $61.66
| Professional | | $42.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $30.90 / $38.02
| Professional | | $25.70 | $30.90 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $34.67 / $48.98
| Professional | | $10.72 | $34.67 | $48.98 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $44.67 / $63.10
| Professional | | $28.84 | $44.67 | $63.10 |