- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.92 / $449.56 / $527.54
| Professional | | $369.92 | $449.56 | $527.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.95 / $704.60 / $845.52
| Professional | | $574.95 | $704.60 | $845.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.15 / $779.45 / $992.42
| Professional | | $659.15 | $779.45 | $992.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.28 / $602.35 / $704.60
| Professional | | $473.28 | $602.35 | $704.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.95 / $704.60 / $1,354.72
| Professional | | $574.95 | $704.60 | $1,354.72 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.98 / $489.75 / $651.98
| Professional | | $93.98 | $489.75 | $651.98 |