- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.71 / $279.60 / $328.94
| Facility | | $246.71 | $279.60 | $328.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.41 / $269.86 / $408.11
| Professional | | $163.41 | $269.86 | $408.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.77 / $207.77 / $407.82
| Professional | | $207.77 | $207.77 | $407.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.27 / $309.45 / $346.58
| Professional | | $41.27 | $309.45 | $346.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.02 / $292.39 / $304.58
| Professional | | $268.02 | $292.39 | $304.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.07 / $328.94 / $417.61
| Professional | | $299.07 | $328.94 | $417.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.27 / $368.25 / $660.05
| Professional | | $273.27 | $368.25 | $660.05 |