- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $6,966.00 / $8,499.00
| Facility | | $2,747.00 | $6,966.00 | $8,499.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.91 / $681.30 / $2,733.14
| Professional | | $662.91 | $681.30 | $2,733.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.11 / $812.36 / $839.59
| Professional | | $651.11 | $812.36 | $839.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $922.51 / $1,061.43 / $8,902.00
| Professional | | $922.51 | $1,061.43 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.88 / $779.87 / $909.85
| Professional | | $714.88 | $779.87 | $909.85 |
- 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
- $662.89 / $812.36 / $1,049.82
| Professional | | $662.89 | $812.36 | $1,049.82 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.49 / $9,435.00 / $12,953.00
| Professional | | $580.49 | $9,435.00 | $12,953.00 |