- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.75 / $71.59 / $71.59
| Professional | | $58.75 | $71.59 | $71.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.94 / $90.77 / $90.77
| Professional | | $70.94 | $90.77 | $90.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.00 / $1,078.00 / $1,078.00
| Facility | | $1,078.00 | $1,078.00 | $1,078.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.83 / $115.23 / $124.46
| Professional | | $87.83 | $115.23 | $124.46 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $29.27 / $29.27
| Professional | | $29.27 | $29.27 | $29.27 |