- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.47 / $148.47 / $148.47
| Facility | | $148.47 | $148.47 | $148.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.00 / $98.15 / $119.00
| Professional | | $48.00 | $98.15 | $119.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.58 / $96.58 / $96.58
| Professional | | $96.58 | $96.58 | $96.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.00 / $93.00 / $93.00
| Professional | | $93.00 | $93.00 | $93.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.98 / $117.79 / $137.41
| Professional | | $107.98 | $117.79 | $137.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.19 / $103.33 / $129.35
| Professional | | $100.19 | $103.33 | $129.35 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.13 / $70.97 / $98.16
| Professional | | $53.13 | $70.97 | $98.16 |