- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.56 / $325.89 / $418.27
| Facility | | $287.56 | $325.89 | $418.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.13 / $227.13 / $227.13
| Professional | | $227.13 | $227.13 | $227.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.27 / $418.27 / $418.27
| Professional | | $418.27 | $418.27 | $418.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.03 / $437.83 / $547.29
| Professional | | $398.03 | $437.83 | $547.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.42 / $418.27 / $487.98
| Professional | | $383.42 | $418.27 | $487.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.04 / $418.27 / $562.08
| Professional | | $395.04 | $418.27 | $562.08 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.27 / $435.70 / $784.26
| Professional | | $296.27 | $435.70 | $784.26 |