- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.52 / $93.52 / $93.52
| Facility | | $93.52 | $93.52 | $93.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.57 / $55.57 / $76.31
| Professional | | $55.57 | $55.57 | $76.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.04 / $55.57 / $61.66
| Professional | | $54.04 | $55.57 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.57 / $63.98 / $79.98
| Professional | | $62.57 | $63.98 | $79.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.57 / $66.68 / $83.35
| Professional | | $55.57 | $66.68 | $83.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.79 / $55.57 / $83.36
| Professional | | $52.79 | $55.57 | $83.36 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.79 / $54.81 / $62.18
| Professional | | $46.79 | $54.81 | $62.18 |