- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.11 / $393.36 / $458.39
| Professional | | $317.11 | $393.36 | $458.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.46 / $630.46 / $756.56
| Professional | | $514.46 | $630.46 | $756.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.16 / $594.95 / $731.53
| Professional | | $515.16 | $594.95 | $731.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.17 / $527.13 / $630.46
| Professional | | $414.17 | $527.13 | $630.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.46 / $630.46 / $1,190.09
| Professional | | $514.46 | $630.46 | $1,190.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.45 / $431.41 / $585.90
| Professional | | $84.45 | $431.41 | $585.90 |