- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $269.15 / $331.13
| Facility | | $229.09 | $269.15 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $346.74
| Professional | | $147.91 | $234.42 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $151.36 / $331.13
| Professional | | $141.25 | $151.36 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $354.81 / $389.05
| Professional | | $275.42 | $354.81 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $331.13 / $416.87
| Professional | | $302.00 | $331.13 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $275.42 / $416.87
| Professional | | $138.04 | $275.42 | $416.87 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $407.38 / $616.60
| Professional | | $234.42 | $407.38 | $616.60 |