- 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
- $487.77 / $520.01 / $939.37
| Professional | | $487.77 | $520.01 | $939.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.54 / $739.14 / $886.97
| Professional | | $570.54 | $739.14 | $886.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.24 / $862.02 / $5,851.00
| Professional | | $767.24 | $862.02 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.44 / $709.57 / $827.83
| Professional | | $650.44 | $709.57 | $827.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $3,028.00 / $3,028.00
| Facility | | $3,028.00 | $3,028.00 | $3,028.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.94 / $739.14 / $923.18
| Professional | | $582.94 | $739.14 | $923.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.53 / $2,582.96 / $6,124.00
| Professional | | $673.53 | $2,582.96 | $6,124.00 |