- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.48 / $346.65 / $1,304.51
| Professional | | $265.48 | $346.65 | $1,304.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.88 / $411.23 / $912.11
| Professional | | $317.88 | $411.23 | $912.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.55 / $428.68 / $492.98
| Professional | | $381.55 | $428.68 | $492.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.72 / $394.78 / $460.57
| Professional | | $348.72 | $394.78 | $460.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.74 / $400.64 / $546.50
| Professional | | $293.74 | $400.64 | $546.50 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.64 / $407.24 / $414.39
| Professional | | $303.64 | $407.24 | $414.39 |