- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.41 / $381.27 / $448.55
| Facility | | $336.41 | $381.27 | $448.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.41 / $227.41 / $227.41
| Professional | | $227.41 | $227.41 | $227.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.51 / $136.51 / $553.29
| Professional | | $136.51 | $136.51 | $553.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.97 / $337.01 / $478.74
| Professional | | $37.97 | $337.01 | $478.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.49 / $398.71 / $415.33
| Professional | | $365.49 | $398.71 | $415.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.76 / $448.55 / $591.53
| Professional | | $319.76 | $448.55 | $591.53 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.28 / $482.56 / $932.33
| Professional | | $191.28 | $482.56 | $932.33 |