- 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
- $723.53 / $776.01 / $1,158.44
| Professional | | $723.53 | $776.01 | $1,158.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.22 / $932.11 / $932.11
| Professional | | $751.22 | $932.11 | $932.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,107.98 / $1,303.51 / $8,902.00
| Professional | | $1,107.98 | $1,303.51 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.26 / $894.83 / $1,043.97
| Professional | | $820.26 | $894.83 | $1,043.97 |
- 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
- $760.60 / $932.11 / $1,210.84
| Professional | | $760.60 | $932.11 | $1,210.84 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $667.38 / $1,252.23
| Professional | | $29.27 | $667.38 | $1,252.23 |