- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $64.57 / $91.20
| Professional | | $45.71 | $64.57 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $60.26 / $91.20
| Professional | | $48.98 | $60.26 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $77.62 / $89.13
| Professional | | $30.20 | $77.62 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $85.11 / $97.72
| Professional | | $54.95 | $85.11 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $60.26 / $91.20
| Professional | | $40.74 | $60.26 | $91.20 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $51.29 / $70.79
| Professional | | $31.62 | $51.29 | $70.79 |