- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.22 / $154.40 / $181.64
| Facility | | $136.22 | $154.40 | $181.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.16 / $85.16 / $85.16
| Professional | | $85.16 | $85.16 | $85.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.96 / $147.96 / $258.16
| Professional | | $147.96 | $147.96 | $258.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.38 / $192.00 / $207.21
| Professional | | $37.38 | $192.00 | $207.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.01 / $161.46 / $168.19
| Professional | | $148.01 | $161.46 | $168.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.64 / $196.59 / $216.15
| Professional | | $181.64 | $196.59 | $216.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.45 / $207.31 / $366.39
| Professional | | $166.45 | $207.31 | $366.39 |