- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.03 / $40.83 / $52.40
| Facility | | $36.03 | $40.83 | $52.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.85 / $46.85 / $47.96
| Professional | | $46.85 | $46.85 | $47.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.80 / $52.40 / $52.40
| Professional | | $31.80 | $52.40 | $52.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.20 / $81.66 / $95.15
| Professional | | $65.20 | $81.66 | $95.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.04 / $52.40 / $61.14
| Professional | | $48.04 | $52.40 | $61.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.40 / $56.03 / $77.86
| Professional | | $52.40 | $56.03 | $77.86 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.64 / $72.28 / $100.85
| Professional | | $34.64 | $72.28 | $100.85 |