- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $794.33 / $954.99
| Facility | | $660.69 | $794.33 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $758.58 / $1,000.00
| Professional | | $501.19 | $758.58 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $954.99
| Professional | | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $933.25 / $1,000.00
| Professional | | $794.33 | $933.25 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $954.99 / $1,202.26
| Professional | | $870.96 | $954.99 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $398.11 / $1,202.26
| Professional | | $331.13 | $398.11 | $1,202.26 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,071.52 / $1,445.44
| Professional | | $676.08 | $1,071.52 | $1,445.44 |