- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.49 / $716.71 / $839.66
| Professional | | $597.49 | $716.71 | $839.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.08 / $928.03 / $1,072.16
| Professional | | $743.08 | $928.03 | $1,072.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.41 / $1,222.56 / $1,358.83
| Professional | | $1,061.41 | $1,222.56 | $1,358.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.71 / $943.50 / $1,200.82
| Professional | | $684.71 | $943.50 | $1,200.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.51 / $1,279.25 / $1,510.62
| Professional | | $944.51 | $1,279.25 | $1,510.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.94 / $2,500.00 / $6,063.00
| Professional | | $759.94 | $2,500.00 | $6,063.00 |