- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $851.14 / $2,884.03
| Facility | | $512.86 | $851.14 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $338.84 / $446.68
| Professional | | $281.84 | $338.84 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $346.74 / $457.09
| Professional | | $323.59 | $346.74 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $2,454.71
| Professional | | $467.74 | $467.74 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $416.87 / $524.81
| Professional | | $354.81 | $416.87 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $416.87 / $501.19
| Professional | | $234.42 | $416.87 | $501.19 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $371.54 / $446.68
| Professional | | $54.95 | $371.54 | $446.68 |