- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $309.03 / $467.74
| Professional | | $181.97 | $309.03 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $363.08 / $489.78
| Professional | | $234.42 | $363.08 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $407.38 / $2,137.96
| Professional | | $331.13 | $407.38 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $371.54 / $478.63
| Professional | | $204.17 | $371.54 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $323.59 / $489.78
| Professional | | $165.96 | $323.59 | $489.78 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $1,412.54 / $3,981.07
| Professional | | $239.88 | $1,412.54 | $3,981.07 |