- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.50 / $260.50 / $331.37
| Professional | | $260.50 | $260.50 | $331.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.80 / $460.54 / $552.65
| Professional | | $375.80 | $460.54 | $552.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.54 / $501.49 / $636.14
| Professional | | $427.54 | $501.49 | $636.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.62 / $382.61 / $460.54
| Professional | | $300.62 | $382.61 | $460.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.80 / $460.54 / $929.52
| Professional | | $375.80 | $460.54 | $929.52 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.72 / $327.90 / $459.05
| Professional | | $61.72 | $327.90 | $459.05 |