- 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
- $427.94 / $666.13 / $1,318.94
| Professional | | $427.94 | $666.13 | $1,318.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.33 / $823.06 / $987.68
| Professional | | $635.33 | $823.06 | $987.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $856.49 / $937.33 / $1,106.63
| Professional | | $856.49 | $937.33 | $1,106.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.30 / $790.14 / $921.83
| Professional | | $724.30 | $790.14 | $921.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $2,912.00 / $2,912.00
| Facility | | $2,912.00 | $2,912.00 | $2,912.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.37 / $823.06 / $1,033.08
| Professional | | $655.37 | $823.06 | $1,033.08 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.88 / $3,619.79 / $9,324.00
| Professional | | $683.88 | $3,619.79 | $9,324.00 |