- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $758.58 / $933.25
| Facility | | $630.96 | $758.58 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $660.69 / $977.24
| Professional | | $288.40 | $660.69 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $933.25
| Professional | | $933.25 | $933.25 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $954.99 / $1,047.13
| Professional | | $776.25 | $954.99 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $933.25 / $1,148.15
| Professional | | $851.14 | $933.25 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $776.25 / $1,148.15
| Professional | | $389.05 | $776.25 | $1,148.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $912.01 / $1,380.38
| Professional | | $398.11 | $912.01 | $1,380.38 |