- 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
- $737.37 / $739.35 / $739.35
| Professional | | $737.37 | $739.35 | $739.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.14 / $886.20 / $886.20
| Professional | | $718.14 | $886.20 | $886.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.40 / $1,146.45 / $8,902.00
| Professional | | $996.40 | $1,146.45 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.86 / $850.75 / $992.54
| Professional | | $779.86 | $850.75 | $992.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.14 / $886.20 / $1,140.75
| Professional | | $723.14 | $886.20 | $1,140.75 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.47 / $2,582.96 / $6,124.00
| Professional | | $631.47 | $2,582.96 | $6,124.00 |