- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $588.84 / $724.44
| Facility | | $489.78 | $588.84 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $512.86 / $758.58
| Professional | | $323.59 | $512.86 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $323.59 / $724.44
| Professional | | $309.03 | $323.59 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $776.25 / $870.96
| Professional | | $602.56 | $776.25 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $724.44 / $891.25
| Professional | | $660.69 | $724.44 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $602.56 / $891.25
| Professional | | $302.00 | $602.56 | $891.25 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $891.25 / $1,348.96
| Professional | | $512.86 | $891.25 | $1,348.96 |