- 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
- $756.81 / $772.79 / $3,069.73
| Professional | | $756.81 | $772.79 | $3,069.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $743.22 / $926.33 / $926.33
| Professional | | $743.22 | $926.33 | $926.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,081.94 / $1,244.86 / $11,782.00
| Professional | | $1,081.94 | $1,244.86 | $11,782.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.17 / $889.27 / $1,037.48
| Professional | | $815.17 | $889.27 | $1,037.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $2,912.00 / $2,912.00
| Facility | | $2,912.00 | $2,912.00 | $2,912.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.88 / $926.33 / $1,199.46
| Professional | | $755.88 | $926.33 | $1,199.46 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.47 / $2,582.96 / $6,124.00
| Professional | | $662.47 | $2,582.96 | $6,124.00 |