- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,583.13 / $3,107.00 / $8,431.00
| Facility | | $2,583.13 | $3,107.00 | $8,431.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.66 / $752.66 / $3,192.40
| Professional | | $752.66 | $752.66 | $3,192.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,800.89 / $3,449.59 / $4,139.51
| Professional | | $2,800.89 | $3,449.59 | $4,139.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.46 / $1,242.48 / $4,474.88
| Professional | | $1,066.46 | $1,242.48 | $4,474.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.97 / $2,925.25 / $3,449.59
| Professional | | $753.97 | $2,925.25 | $3,449.59 |
- 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
- $2,814.86 / $3,440.03 / $4,904.18
| Professional | | $2,814.86 | $3,440.03 | $4,904.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.51 / $4,635.00 / $11,157.00
| Professional | | $810.51 | $4,635.00 | $11,157.00 |