- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.04 / $112.04 / $157.49
| Facility | | $112.04 | $112.04 | $157.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.31 / $140.91 / $582.41
| Professional | | $117.31 | $140.91 | $582.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.46 / $177.46 / $177.46
| Facility | | $177.46 | $177.46 | $177.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.72 / $146.97 / $216.47
| Professional | | $125.72 | $146.97 | $216.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.60 / $211.99 / $296.67
| Professional | | $88.60 | $211.99 | $296.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.63 / $272.45 / $285.69
| Professional | | $92.63 | $272.45 | $285.69 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.78 / $31.50 / $45.68
| Professional | | $26.78 | $31.50 | $45.68 |