- 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
- $346.74 / $407.38 / $549.54
| Professional | | $346.74 | $407.38 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $3,235.94
| Facility | | $3,235.94 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $1,412.54
| Professional | | $371.54 | $524.81 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $660.69 / $6,456.54
| Professional | | $575.44 | $660.69 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $398.11 / $489.78
| Professional | | $331.13 | $398.11 | $489.78 |
- 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
- $354.81 / $478.63 / $758.58
| Professional | | $354.81 | $478.63 | $758.58 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $426.58 / $758.58
| Professional | | $29.51 | $426.58 | $758.58 |