- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,454.71 / $3,467.37
| Professional | | $1,862.09 | $2,454.71 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $660.69 / $1,047.13
| Professional | | $446.68 | $660.69 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $831.76 / $912.01
| Professional | | $575.44 | $831.76 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $81.28 / $95.50
| Professional | | $75.86 | $81.28 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $3,388.44 / $4,168.69
| Professional | | $724.44 | $3,388.44 | $4,168.69 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $114.82 / $851.14
| Professional | | $66.07 | $114.82 | $851.14 |