- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.13 / $74.38 / $198.34
| Facility | | $51.13 | $74.38 | $198.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.36 / $54.02 / $74.38
| Professional | | $51.36 | $54.02 | $74.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.08 / $74.38 / $74.38
| Professional | | $49.08 | $74.38 | $74.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.30 / $77.81 / $94.70
| Professional | | $61.30 | $77.81 | $94.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.98 / $74.38 / $92.97
| Professional | | $61.98 | $74.38 | $92.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.38 / $74.38 / $92.97
| Professional | | $74.38 | $74.38 | $92.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.98 / $112.57 / $155.86
| Professional | | $61.98 | $112.57 | $155.86 |