- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.54 / $471.54 / $1,870.36
| Professional | | $471.54 | $471.54 | $1,870.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.32 / $285.32 / $285.32
| Facility | | $285.32 | $285.32 | $285.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.12 / $319.77 / $414.42
| Professional | | $229.12 | $319.77 | $414.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.33 / $360.57 / $443.71
| Professional | | $46.33 | $360.57 | $443.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.86 / $58.75 / $68.54
| Professional | | $53.86 | $58.75 | $68.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.74 / $2,862.78 / $3,031.61
| Professional | | $884.74 | $2,862.78 | $3,031.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.22 / $76.47 / $434.01
| Professional | | $44.22 | $76.47 | $434.01 |