- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.45 / $305.37 / $359.26
| Facility | | $269.45 | $305.37 | $359.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.64 / $186.64 / $186.64
| Professional | | $186.64 | $186.64 | $186.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.65 / $219.65 / $545.02
| Professional | | $219.65 | $219.65 | $545.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.00 / $396.14 / $427.83
| Professional | | $37.00 | $396.14 | $427.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.73 / $319.33 / $332.65
| Professional | | $292.73 | $319.33 | $332.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.26 / $370.50 / $482.45
| Professional | | $359.26 | $370.50 | $482.45 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.45 / $418.12 / $748.63
| Professional | | $309.45 | $418.12 | $748.63 |