- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.91 / $491.76 / $578.54
| Facility | | $433.91 | $491.76 | $578.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.11 / $587.54 / $1,823.36
| Professional | | $373.11 | $587.54 | $1,823.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.08 / $452.93 / $578.54
| Professional | | $329.08 | $452.93 | $578.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.02 / $614.16 / $679.39
| Professional | | $525.02 | $614.16 | $679.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.41 / $514.26 / $599.97
| Professional | | $441.41 | $514.26 | $599.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.10 / $578.54 / $678.74
| Professional | | $499.10 | $578.54 | $678.74 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.83 / $633.54 / $1,013.73
| Professional | | $436.83 | $633.54 | $1,013.73 |