- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.93 / $364.93 / $386.92
| Facility | | $364.93 | $364.93 | $386.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.74 / $312.89 / $549.60
| Professional | | $264.74 | $312.89 | $549.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $307.55
| Professional | | $307.55 | $307.55 | $307.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.43 / $296.43 / $296.43
| Professional | | $296.43 | $296.43 | $296.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.19 / $375.48 / $438.06
| Professional | | $344.19 | $375.48 | $438.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.54 / $357.64 / $411.90
| Professional | | $334.54 | $357.64 | $411.90 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.45 / $274.64 / $288.33
| Professional | | $261.45 | $274.64 | $288.33 |