- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.60 / $9.60 / $94.98
| Professional | | $9.60 | $9.60 | $94.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.02 / $195.53 / $195.53
| Professional | | $60.02 | $195.53 | $195.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.50 / $82.20 / $82.20
| Professional | | $78.50 | $82.20 | $82.20 |
- 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
- $67.39 / $79.29 / $79.29
| Professional | | $67.39 | $79.29 | $79.29 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.50 / $78.50 / $86.35
| Professional | | $78.50 | $78.50 | $86.35 |