- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.96 / $60.02 / $77.03
| Facility | | $52.96 | $60.02 | $77.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.56 / $77.03 / $77.03
| Professional | | $23.56 | $77.03 | $77.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.13 / $67.20 / $75.73
| Professional | | $57.13 | $67.20 | $75.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.19 / $77.03 / $96.29
| Professional | | $64.19 | $77.03 | $96.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.96 / $77.03 / $96.29
| Professional | | $26.96 | $77.03 | $96.29 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.56 / $86.66 / $115.54
| Professional | | $54.56 | $86.66 | $115.54 |