- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $954.99 / $1,122.02
| Facility | | $851.14 | $954.99 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $660.69 / $977.24
| Professional | | $512.86 | $660.69 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $660.69 / $1,584.89
| Professional | | $575.44 | $660.69 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $616.60 / $1,071.52
| Professional | | $549.54 | $616.60 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,023.29 / $1,202.26
| Professional | | $851.14 | $1,023.29 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $870.96 / $1,258.93
| Professional | | $549.54 | $870.96 | $1,258.93 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,202.26 / $1,659.59
| Professional | | $707.95 | $1,202.26 | $1,659.59 |