- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.85 / $38.49 / $50.17
| Professional | | $34.85 | $38.49 | $50.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.45 / $77.45 / $77.45
| Facility | | $77.45 | $77.45 | $77.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.60 / $48.89 / $82.68
| Professional | | $37.60 | $48.89 | $82.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.45 / $81.09 / $81.09
| Professional | | $77.45 | $81.09 | $81.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.44 / $74.92 / $104.89
| Professional | | $52.44 | $74.92 | $104.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.41 / $46.79 / $92.70
| Professional | | $23.41 | $46.79 | $92.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.67 / $72.84 / $198.12
| Professional | | $64.67 | $72.84 | $198.12 |