- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.53 / $390.53 / $514.23
| Professional | | $390.53 | $390.53 | $514.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.91 / $696.90 / $836.28
| Professional | | $533.91 | $696.90 | $836.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.12 / $676.56 / $837.80
| Professional | | $562.12 | $676.56 | $837.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.44 / $590.97 / $696.90
| Professional | | $417.44 | $590.97 | $696.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.28 / $696.90 / $869.45
| Professional | | $534.28 | $696.90 | $869.45 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.23 / $1,402.00 / $3,725.00
| Professional | | $436.23 | $1,402.00 | $3,725.00 |