- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $2,747.00 / $4,456.00
| Facility | | $1,324.03 | $2,747.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.80 / $608.80 / $608.80
| Professional | | $608.80 | $608.80 | $608.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $619.94 / $804.18 / $965.01
| Professional | | $619.94 | $804.18 | $965.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $834.69 / $913.48 / $1,078.47
| Professional | | $834.69 | $913.48 | $1,078.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.67 / $772.01 / $900.68
| Professional | | $707.67 | $772.01 | $900.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $627.62 / $804.18 / $1,005.39
| Professional | | $627.62 | $804.18 | $1,005.39 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $615.21 / $2,575.00 / $6,124.00
| Professional | | $615.21 | $2,575.00 | $6,124.00 |