- 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
- $806.19 / $822.57 / $822.57
| Professional | | $806.19 | $822.57 | $822.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.79 / $990.99 / $990.99
| Professional | | $791.79 | $990.99 | $990.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.83 / $1,214.83 / $8,902.00
| Professional | | $1,055.83 | $1,214.83 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $872.07 / $951.35 / $1,109.91
| Professional | | $872.07 | $951.35 | $1,109.91 |
- 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
- $808.65 / $990.99 / $1,279.91
| Professional | | $808.65 | $990.99 | $1,279.91 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $772.75 / $2,582.96 / $6,124.00
| Professional | | $772.75 | $2,582.96 | $6,124.00 |