- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.84 / $155.08 / $182.45
| Facility | | $136.84 | $155.08 | $182.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.41 / $90.41 / $90.41
| Professional | | $90.41 | $90.41 | $90.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.58 / $182.45 / $216.73
| Professional | | $136.58 | $182.45 | $216.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.12 / $190.99 / $270.86
| Professional | | $118.12 | $190.99 | $270.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.19 / $162.18 / $189.21
| Professional | | $139.19 | $162.18 | $189.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.45 / $223.10 / $234.03
| Professional | | $182.45 | $223.10 | $234.03 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.26 / $230.92 / $373.71
| Professional | | $167.26 | $230.92 | $373.71 |