- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.53 / $140.18 / $237.92
| Professional | | $131.53 | $140.18 | $237.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.03 / $172.07 / $256.36
| Professional | | $145.03 | $172.07 | $256.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.58 / $258.39 / $4,334.00
| Professional | | $224.58 | $258.39 | $4,334.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.68 / $225.60 / $287.13
| Professional | | $164.68 | $225.60 | $287.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.86 / $256.36 / $286.70
| Professional | | $178.86 | $256.36 | $286.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.09 / $191.71 / $286.44
| Professional | | $36.09 | $191.71 | $286.44 |