- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.13 / $126.30 / $160.47
| Professional | | $102.13 | $126.30 | $160.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.62 / $174.36 / $296.62
| Professional | | $124.62 | $174.36 | $296.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.62 / $170.17 / $190.31
| Professional | | $45.62 | $170.17 | $190.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.37 / $48.41 / $56.48
| Professional | | $44.37 | $48.41 | $56.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.15 / $162.63 / $228.09
| Professional | | $67.15 | $162.63 | $228.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.28 / $62.74 / $216.03
| Professional | | $36.28 | $62.74 | $216.03 |