- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.83 / $520.01 / $611.78
| Facility | | $458.83 | $520.01 | $611.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.66 / $274.66 / $274.66
| Professional | | $274.66 | $274.66 | $274.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.64 / $306.77 / $611.78
| Professional | | $305.64 | $306.77 | $611.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.39 / $250.16 / $585.74
| Professional | | $209.39 | $250.16 | $585.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.17 / $543.79 / $634.44
| Professional | | $453.17 | $543.79 | $634.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.67 / $611.78 / $674.57
| Professional | | $426.67 | $611.78 | $674.57 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.40 / $595.64 / $1,012.02
| Professional | | $389.40 | $595.64 | $1,012.02 |