- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $208.93 / $245.47
| Facility | | $186.21 | $208.93 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $181.97 / $302.00
| Professional | | $144.54 | $181.97 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $245.47 / $478.63
| Professional | | $169.82 | $245.47 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $295.12 / $295.12
| Professional | | $245.47 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $229.09 / $263.03
| Professional | | $208.93 | $229.09 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $263.03 / $380.19
| Professional | | $169.82 | $263.03 | $380.19 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $275.42 / $512.86
| Professional | | $229.09 | $275.42 | $512.86 |