- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.76 / $125.62 / $161.47
| Professional | | $105.76 | $125.62 | $161.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.01 / $283.01 / $283.01
| Professional | | $283.01 | $283.01 | $283.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.11 / $181.27 / $222.83
| Professional | | $173.11 | $181.27 | $222.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.29 / $183.95 / $191.61
| Professional | | $153.29 | $183.95 | $191.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.33 / $191.61 / $213.65
| Professional | | $146.33 | $191.61 | $213.65 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $118.66 / $161.94
| Professional | | $97.72 | $118.66 | $161.94 |