- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,583.13 / $3,107.00 / $8,431.00
| Facility | | $2,583.13 | $3,107.00 | $8,431.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.84 / $507.84 / $637.62
| Professional | | $507.84 | $507.84 | $637.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.43 / $869.59 / $1,043.51
| Professional | | $686.43 | $869.59 | $1,043.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.79 / $968.91 / $1,093.27
| Professional | | $823.79 | $968.91 | $1,093.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.04 / $765.24 / $869.59
| Professional | | $580.04 | $765.24 | $869.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $1,981.00 / $1,981.00
| Facility | | $1,981.00 | $1,981.00 | $1,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.71 / $869.51 / $1,128.10
| Professional | | $683.71 | $869.51 | $1,128.10 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $622.58 / $4,682.00 / $11,157.30
| Professional | | $622.58 | $4,682.00 | $11,157.30 |