- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.85 / $88.67 / $104.92
| Professional | | $48.85 | $88.67 | $104.92 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $103.42 / $103.42 / $103.42
| Professional | 25 | $103.42 | $103.42 | $103.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.54 / $67.33 / $110.84
| Professional | | $37.54 | $67.33 | $110.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.39 / $85.01 / $106.25
| Professional | | $70.39 | $85.01 | $106.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.70 / $75.00 / $115.27
| Professional | | $49.70 | $75.00 | $115.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.88 / $95.76 / $110.84
| Professional | | $46.88 | $95.76 | $110.84 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.74 / $73.63 / $110.64
| Professional | | $41.74 | $73.63 | $110.64 |