- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.67 / $240.67 / $240.67
| Professional | | $240.67 | $240.67 | $240.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.27 / $520.27 / $520.27
| Facility | | $520.27 | $520.27 | $520.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.07 / $434.07 / $720.41
| Professional | | $434.07 | $434.07 | $720.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.91 / $685.78 / $685.78
| Professional | | $654.91 | $685.78 | $685.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.95 / $654.91 / $916.89
| Professional | | $392.95 | $654.91 | $916.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.22 / $520.27 / $720.41
| Professional | | $351.22 | $520.27 | $720.41 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.55 / $545.64 / $623.36
| Professional | | $527.55 | $545.64 | $623.36 |