- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $194.98 / $363.08
| Professional | | $120.23 | $194.98 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $239.88 / $331.13
| Professional | | $131.83 | $239.88 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $275.42 / $4,570.88
| Professional | | $223.87 | $275.42 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $269.15 / $338.84
| Professional | | $138.04 | $269.15 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $257.04 / $371.54
| Professional | | $151.36 | $257.04 | $371.54 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $239.88 / $5,248.07
| Professional | | $45.71 | $239.88 | $5,248.07 |