- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $380.19 / $446.68
| Facility | | $338.84 | $380.19 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $281.84 / $478.63
| Professional | | $229.09 | $281.84 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $446.68 / $741.31
| Professional | | $138.04 | $446.68 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $549.54 / $575.44
| Professional | | $457.09 | $549.54 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $398.11 / $467.74
| Professional | | $363.08 | $398.11 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $316.23 / $588.84
| Professional | | $251.19 | $316.23 | $588.84 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $478.63 / $812.83
| Professional | | $190.55 | $478.63 | $812.83 |