- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.49 / $135.41 / $159.31
| Facility | | $119.49 | $135.41 | $159.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.65 / $75.65 / $75.65
| Professional | | $75.65 | $75.65 | $75.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.31 / $191.09 / $215.86
| Professional | | $159.31 | $191.09 | $215.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.96 / $250.41 / $286.27
| Professional | | $36.96 | $250.41 | $286.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.81 / $141.61 / $147.51
| Professional | | $129.81 | $141.61 | $147.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.31 / $191.37 / $212.85
| Professional | | $159.31 | $191.37 | $212.85 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.25 / $203.70 / $342.99
| Professional | | $146.25 | $203.70 | $342.99 |