- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $218.78 / $263.03
| Facility | | $181.97 | $218.78 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $208.93 / $346.74
| Professional | | $162.18 | $208.93 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $154.88 / $263.03
| Professional | | $154.88 | $154.88 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $389.05 / $436.52
| Professional | | $302.00 | $389.05 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $263.03 / $331.13
| Professional | | $245.47 | $263.03 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $263.03 / $426.58
| Professional | | $151.36 | $263.03 | $426.58 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $295.12 / $501.19
| Professional | | $186.21 | $295.12 | $501.19 |