- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.93 / $22.63 / $95.98
| Professional | | $18.93 | $22.63 | $95.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.51 / $63.72 / $115.99
| Professional | | $13.51 | $63.72 | $115.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.46 / $119.60 / $125.24
| Professional | | $101.46 | $119.60 | $125.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.75 / $31.02 / $120.63
| Professional | | $22.75 | $31.02 | $120.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.35 / $100.21 / $115.99
| Professional | | $63.35 | $100.21 | $115.99 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $63.01 / $84.18
| Professional | | $18.62 | $63.01 | $84.18 |