- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.59 / $36.11 / $72.34
| Professional | | $2.59 | $36.11 | $72.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.70 / $21.70 / $21.70
| Professional | | $21.70 | $21.70 | $21.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.00 / $72.25 / $72.25
| Professional | | $69.00 | $72.25 | $72.25 |
- 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
- $74.00 / $74.00 / $81.40
| Professional | | $74.00 | $74.00 | $81.40 |