- 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
- $484.24 / $583.45 / $1,013.98
| Professional | | $484.24 | $583.45 | $1,013.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.29 / $798.16 / $957.80
| Professional | | $606.29 | $798.16 | $957.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.16 / $906.33 / $1,070.04
| Professional | | $828.16 | $906.33 | $1,070.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.38 / $766.24 / $893.94
| Professional | | $702.38 | $766.24 | $893.94 |
- 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
- $651.29 / $798.16 / $997.94
| Professional | | $651.29 | $798.16 | $997.94 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.02 / $2,582.96 / $6,124.00
| Professional | | $759.02 | $2,582.96 | $6,124.00 |