- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $549.54 / $660.69
| Facility | | $457.09 | $549.54 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $501.19 / $562.34
| Professional | | $38.02 | $501.19 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Professional | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,000.00 / $1,148.15
| Professional | | $794.33 | $1,000.00 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $660.69 / $831.76
| Professional | | $616.60 | $660.69 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $562.34 / $831.76
| Professional | | $275.42 | $562.34 | $831.76 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $870.96 / $1,258.93
| Professional | | $467.74 | $870.96 | $1,258.93 |