- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.33 / $154.33 / $192.63
| Facility | | $154.33 | $154.33 | $192.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.72 / $148.90 / $199.53
| Professional | | $105.72 | $148.90 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.00 / $126.55 / $214.21
| Professional | | $90.00 | $126.55 | $214.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.91 / $182.55 / $200.81
| Professional | | $136.91 | $182.55 | $200.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.00 / $167.66 / $205.64
| Professional | | $138.00 | $167.66 | $205.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.15 / $174.80 / $224.19
| Professional | | $131.15 | $174.80 | $224.19 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.94 / $157.15 / $212.61
| Professional | | $132.94 | $157.15 | $212.61 |