- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.27 / $501.24 / $589.69
| Facility | | $442.27 | $501.24 | $589.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.74 / $300.74 / $300.74
| Professional | | $300.74 | $300.74 | $300.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.41 / $258.41 / $699.72
| Professional | | $258.41 | $258.41 | $699.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.25 / $511.23 / $631.25
| Professional | | $45.25 | $511.23 | $631.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.49 / $524.16 / $546.01
| Professional | | $480.49 | $524.16 | $546.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.98 / $589.69 / $785.97
| Professional | | $473.98 | $589.69 | $785.97 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.22 / $664.51 / $1,246.30
| Professional | | $367.22 | $664.51 | $1,246.30 |