- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.00 / $686.00 / $754.60
| Professional | | $686.00 | $686.00 | $754.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.91 / $686.00 / $830.48
| Professional | | $685.91 | $686.00 | $830.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.65 / $799.65 / $799.65
| Professional | | $799.65 | $799.65 | $799.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.00 / $823.20 / $960.40
| Professional | | $686.00 | $823.20 | $960.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.13 / $686.00 / $1,029.00
| Professional | | $655.13 | $686.00 | $1,029.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.82 / $777.17 / $828.55
| Professional | | $737.82 | $777.17 | $828.55 |