- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.46 / $240.49 / $432.36
| Professional | | $232.46 | $240.49 | $432.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.26 / $519.92 / $623.91
| Professional | | $424.26 | $519.92 | $623.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.75 / $439.06 / $655.14
| Professional | | $351.75 | $439.06 | $655.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.53 / $415.94 / $519.92
| Professional | | $253.53 | $415.94 | $519.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.26 / $519.92 / $736.34
| Professional | | $424.26 | $519.92 | $736.34 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.63 / $279.06 / $496.95
| Professional | | $71.63 | $279.06 | $496.95 |