- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $2,747.00 / $6,084.00
| Facility | | $2,528.00 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.21 / $715.50 / $1,162.26
| Professional | | $640.21 | $715.50 | $1,162.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.90 / $918.33 / $1,101.99
| Professional | | $709.90 | $918.33 | $1,101.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.87 / $1,060.32 / $1,251.83
| Professional | | $968.87 | $1,060.32 | $1,251.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.13 / $881.59 / $1,028.52
| Professional | | $808.13 | $881.59 | $1,028.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $3,028.00 / $3,028.00
| Facility | | $3,028.00 | $3,028.00 | $3,028.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $749.35 / $918.33 / $1,157.54
| Professional | | $749.35 | $918.33 | $1,157.54 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $743.48 / $984.14
| Professional | | $29.27 | $743.48 | $984.14 |