- 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
- $506.19 / $651.19 / $938.04
| Professional | | $506.19 | $651.19 | $938.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $750.69 / $962.15 / $1,154.58
| Professional | | $750.69 | $962.15 | $1,154.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.75 / $1,057.09 / $1,183.57
| Professional | | $917.75 | $1,057.09 | $1,183.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.78 / $846.69 / $962.15
| Professional | | $646.78 | $846.69 | $962.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $1,689.00 / $1,689.00
| Facility | | $1,689.00 | $1,689.00 | $1,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.19 / $962.15 / $1,199.93
| Professional | | $736.19 | $962.15 | $1,199.93 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.70 / $4,682.00 / $11,157.30
| Professional | | $660.70 | $4,682.00 | $11,157.30 |