- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.10 / $472.16 / $699.53
| Professional | | $374.10 | $472.16 | $699.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.11 / $687.64 / $825.17
| Professional | | $561.11 | $687.64 | $825.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.92 / $800.43 / $993.38
| Professional | | $694.92 | $800.43 | $993.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.19 / $605.12 / $687.64
| Professional | | $479.19 | $605.12 | $687.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.11 / $687.64 / $1,376.86
| Professional | | $561.11 | $687.64 | $1,376.86 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.90 / $509.45 / $665.28
| Professional | | $95.90 | $509.45 | $665.28 |