- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.38 / $264.49 / $339.46
| Facility | | $233.38 | $264.49 | $339.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.93 / $149.93 / $149.93
| Professional | | $149.93 | $149.93 | $149.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.11 / $339.46 / $339.46
| Professional | | $154.11 | $339.46 | $339.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.88 / $333.80 / $388.96
| Professional | | $282.88 | $333.80 | $388.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.17 / $339.46 / $396.03
| Professional | | $311.17 | $339.46 | $396.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.88 / $339.46 / $424.32
| Professional | | $282.88 | $339.46 | $424.32 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.45 / $381.89 / $636.48
| Professional | | $240.45 | $381.89 | $636.48 |