- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.58 / $484.59 / $621.94
| Facility | | $427.58 | $484.59 | $621.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.69 / $274.69 / $274.69
| Professional | | $274.69 | $274.69 | $274.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.52 / $621.94 / $621.94
| Professional | | $291.52 | $621.94 | $621.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.43 / $840.67 / $979.60
| Professional | | $712.43 | $840.67 | $979.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.11 / $621.94 / $725.59
| Professional | | $570.11 | $621.94 | $725.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.28 / $777.42 / $777.42
| Professional | | $518.28 | $777.42 | $777.42 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.54 / $699.68 / $1,166.13
| Professional | | $440.54 | $699.68 | $1,166.13 |