- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.45 / $45.09 / $51.65
| Professional | | $35.45 | $45.09 | $51.65 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $17.73 / $22.55 / $25.83
| Professional | 52 | $17.73 | $22.55 | $25.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.82 / $43.87 / $60.35
| Professional | | $31.82 | $43.87 | $60.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.30 / $57.30 / $57.30
| Professional | | $57.30 | $57.30 | $57.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.68 / $44.68 / $52.81
| Professional | | $35.68 | $44.68 | $52.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.43 / $48.68 / $61.84
| Professional | | $41.43 | $48.68 | $61.84 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.20 / $50.39 / $73.51
| Professional | | $38.20 | $50.39 | $73.51 |