- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.80 / $110.09 / $157.72
| Professional | | $43.80 | $110.09 | $157.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $134.74 / $260.58
| Professional | | $45.00 | $134.74 | $260.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.66 / $169.48 / $199.78
| Professional | | $147.66 | $169.48 | $199.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.88 / $135.50 / $189.70
| Professional | | $48.88 | $135.50 | $189.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.69 / $163.98 / $215.97
| Professional | | $104.69 | $163.98 | $215.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.41 / $165.40 / $287.38
| Professional | | $48.41 | $165.40 | $287.38 |