- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $2,747.00 / $4,456.00
| Facility | | $1,324.03 | $2,747.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.53 / $686.70 / $686.70
| Professional | | $652.53 | $686.70 | $686.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.09 / $791.14 / $791.14
| Professional | | $627.09 | $791.14 | $791.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $918.52 / $1,031.98 / $1,217.74
| Professional | | $918.52 | $1,031.98 | $1,217.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.20 / $759.49 / $886.07
| Professional | | $696.20 | $759.49 | $886.07 |
- 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
- $645.57 / $791.14 / $1,015.52
| Professional | | $645.57 | $791.14 | $1,015.52 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.47 / $2,575.00 / $6,124.00
| Professional | | $563.47 | $2,575.00 | $6,124.00 |