- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,560.34 / $2,585.69 / $10,519.30
| Facility | | $1,560.34 | $2,585.69 | $10,519.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.08 / $720.07 / $2,353.06
| Professional | | $389.08 | $720.07 | $2,353.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.05 / $776.78 / $932.13
| Professional | | $612.05 | $776.78 | $932.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.88 / $770.25 / $975.95
| Professional | | $654.88 | $770.25 | $975.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.15 / $658.71 / $776.78
| Professional | | $470.15 | $658.71 | $776.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $1,981.00 / $1,981.00
| Facility | | $1,981.00 | $1,981.00 | $1,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $623.35 / $776.78 / $1,017.75
| Professional | | $623.35 | $776.78 | $1,017.75 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.96 / $2,500.00 / $6,063.00
| Professional | | $513.96 | $2,500.00 | $6,063.00 |