- 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
- $379.91 / $463.91 / $2,175.00
| Professional | | $379.91 | $463.91 | $2,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.03 / $579.54 / $695.46
| Professional | | $444.03 | $579.54 | $695.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.75 / $670.47 / $2,077.00
| Professional | | $596.75 | $670.47 | $2,077.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.00 / $556.37 / $649.10
| Professional | | $510.00 | $556.37 | $649.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $1,689.00 / $1,689.00
| Facility | | $1,689.00 | $1,689.00 | $1,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $579.54 / $718.92
| Professional | | $446.68 | $579.54 | $718.92 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.96 / $2,575.00 / $6,124.00
| Professional | | $513.96 | $2,575.00 | $6,124.00 |