- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.77 / $270.77 / $270.77
| Facility | | $270.77 | $270.77 | $270.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.38 / $219.81 / $307.82
| Professional | | $146.38 | $219.81 | $307.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.37 / $241.37 / $241.37
| Professional | | $241.37 | $241.37 | $241.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.75 / $232.75 / $232.75
| Professional | | $232.75 | $232.75 | $232.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.72 / $258.61 / $323.27
| Professional | | $201.72 | $258.61 | $323.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.13 / $180.15 / $226.28
| Professional | | $153.13 | $180.15 | $226.28 |