- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $680.00 / $800.00
| Facility | | $600.00 | $680.00 | $800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.38 / $362.38 / $362.38
| Professional | | $362.38 | $362.38 | $362.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.99 / $460.88 / $800.00
| Professional | | $407.99 | $460.88 | $800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.42 / $351.27 / $767.12
| Professional | | $258.42 | $351.27 | $767.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.59 / $711.11 / $829.63
| Professional | | $592.59 | $711.11 | $829.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.69 / $800.00 / $887.70
| Professional | | $594.69 | $800.00 | $887.70 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.45 / $855.79 / $1,331.98
| Professional | | $508.45 | $855.79 | $1,331.98 |