- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.40 / $93.40 / $93.40
| Facility | | $93.40 | $93.40 | $93.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.78 / $4,195.67 / $8,112.00
| Professional | | $52.78 | $4,195.67 | $8,112.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.40 / $93.40 / $93.40
| Facility | | $93.40 | $93.40 | $93.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.74 / $50.74 / $50.74
| Professional | | $50.74 | $50.74 | $50.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.95 / $71.95 / $71.95
| Professional | | $71.95 | $71.95 | $71.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.81 / $60.88 / $71.03
| Professional | | $55.81 | $60.88 | $71.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.83 / $59.14 / $76.11
| Professional | | $56.83 | $59.14 | $76.11 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.18 / $58.43 / $63.57
| Professional | | $46.18 | $58.43 | $63.57 |