- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.25 / $23.98 / $29.52
| Professional | | $22.25 | $23.98 | $29.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.58 / $31.05 / $77.00
| Professional | | $21.58 | $31.05 | $77.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.62 / $34.76 / $38.40
| Professional | | $4.62 | $34.76 | $38.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.00 / $670.00 / $670.00
| Professional | | $670.00 | $670.00 | $670.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.59 / $28.41 / $42.91
| Professional | | $20.59 | $28.41 | $42.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $11.40 / $12.40
| Professional | | $7.00 | $11.40 | $12.40 |