- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.14 / $60.22 / $77.29
| Facility | | $53.14 | $60.22 | $77.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.04 / $77.29 / $77.29
| Professional | | $51.04 | $77.29 | $77.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.75 / $138.16 / $161.69
| Professional | | $104.75 | $138.16 | $161.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.41 / $77.29 / $96.62
| Professional | | $64.41 | $77.29 | $96.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.05 / $77.29 / $125.03
| Professional | | $27.05 | $77.29 | $125.03 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.14 / $116.99 / $161.97
| Professional | | $72.14 | $116.99 | $161.97 |