- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.48 / $81.59 / $326.39
| Facility | | $31.48 | $81.59 | $326.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.98 / $20.98 / $20.98
| Professional | | $20.98 | $20.98 | $20.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.94 / $13.94 / $13.94
| Professional | | $13.94 | $13.94 | $13.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.52 / $42.88 / $50.20
| Professional | | $32.52 | $42.88 | $50.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.49 / $31.49 / $47.24
| Professional | | $31.49 | $31.49 | $47.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $13.55 / $62.55
| Professional | | $13.55 | $13.55 | $62.55 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.02 / $25.64 / $42.35
| Professional | | $16.02 | $25.64 | $42.35 |