- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.38 / $306.38 / $306.38
| Professional | | $306.38 | $306.38 | $306.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.47 / $674.47 / $674.47
| Facility | | $674.47 | $674.47 | $674.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.45 / $361.45 / $933.91
| Professional | | $361.45 | $361.45 | $933.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.01 / $889.02 / $889.02
| Professional | | $849.01 | $889.02 | $889.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.41 / $849.01 / $1,188.60
| Professional | | $509.41 | $849.01 | $1,188.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.92 / $674.47 / $1,058.91
| Professional | | $402.92 | $674.47 | $1,058.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.31 / $683.91 / $808.10
| Professional | | $371.31 | $683.91 | $808.10 |