- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $354.81 / $416.87
| Facility | | $309.03 | $354.81 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $263.03 / $446.68
| Professional | | $208.93 | $263.03 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $416.87 / $676.08
| Professional | | $218.78 | $416.87 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $489.78 / $501.19
| Professional | | $407.38 | $489.78 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $380.19 / $446.68
| Professional | | $346.74 | $380.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $380.19 / $537.03
| Professional | | $288.40 | $380.19 | $537.03 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $467.74 / $851.14
| Professional | | $295.12 | $467.74 | $851.14 |