- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.43 / $2,747.00 / $6,084.00
| Facility | | $1,861.43 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.10 / $736.10 / $737.85
| Professional | | $736.10 | $736.10 | $737.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $718.86 / $891.31 / $891.31
| Professional | | $718.86 | $891.31 | $891.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $973.31 / $1,119.88 / $8,902.00
| Professional | | $973.31 | $1,119.88 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.36 / $855.66 / $998.27
| Professional | | $784.36 | $855.66 | $998.27 |
- 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
- $727.31 / $899.81 / $1,168.60
| Professional | | $727.31 | $899.81 | $1,168.60 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $875.05 / $3,692.19 / $9,324.00
| Professional | | $875.05 | $3,692.19 | $9,324.00 |