- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.66 / $789.55 / $928.88
| Facility | | $696.66 | $789.55 | $928.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.45 / $441.45 / $441.45
| Professional | | $441.45 | $441.45 | $441.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.30 / $313.89 / $928.88
| Professional | | $212.30 | $313.89 | $928.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.65 / $397.86 / $964.16
| Professional | | $100.65 | $397.86 | $964.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $708.70 / $825.67 / $963.28
| Professional | | $708.70 | $825.67 | $963.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.09 / $928.88 / $1,050.33
| Professional | | $432.09 | $928.88 | $1,050.33 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.48 / $697.40 / $1,215.11
| Professional | | $288.48 | $697.40 | $1,215.11 |