- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.97 / $104.55 / $232.78
| Facility | | $14.97 | $104.55 | $232.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.82 / $19.95 / $39.90
| Professional | | $15.82 | $19.95 | $39.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.33 / $21.77 / $21.77
| Professional | | $14.33 | $21.77 | $21.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.49 / $38.90 / $45.57
| Professional | | $29.49 | $38.90 | $45.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.14 / $21.77 / $25.58
| Professional | | $18.14 | $21.77 | $25.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.62 / $21.77 / $35.22
| Professional | | $7.62 | $21.77 | $35.22 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.32 / $32.96 / $45.63
| Professional | | $20.32 | $32.96 | $45.63 |