- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.02 / $2,815.77 / $2,924.19
| Facility | | $45.02 | $2,815.77 | $2,924.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.37 / $1,668.60 / $4,839.30
| Professional | | $29.37 | $1,668.60 | $4,839.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.02 / $45.02 / $45.02
| Facility | | $45.02 | $45.02 | $45.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $29.38
| Professional | | $29.38 | $29.38 | $29.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.38 / $40.38 / $40.38
| Professional | | $40.38 | $40.38 | $40.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.32 / $35.26 / $41.13
| Professional | | $32.32 | $35.26 | $41.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.71 / $33.19 / $44.07
| Professional | | $32.71 | $33.19 | $44.07 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.30 / $26.96 / $33.47
| Professional | | $21.30 | $26.96 | $33.47 |