- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,466.84 / $4,466.84
| Facility | | $1,778.28 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $794.33 / $870.96
| Professional | | $426.58 | $794.33 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $812.83
| Professional | | $741.31 | $741.31 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $9,772.37 / $15,135.61
| Professional | | $891.25 | $9,772.37 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $758.58 / $870.96
| Professional | | $691.83 | $758.58 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $3,019.95
| Facility | | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $776.25 / $1,023.29
| Professional | | $660.69 | $776.25 | $1,023.29 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $3,235.94 / $6,165.95
| Professional | | $812.83 | $3,235.94 | $6,165.95 |