- 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
- $726.94 / $1,208.49 / $3,260.00
| Professional | | $726.94 | $1,208.49 | $3,260.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $736.50 / $933.29 / $1,119.95
| Professional | | $736.50 | $933.29 | $1,119.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,005.06 / $1,129.21 / $5,851.00
| Professional | | $1,005.06 | $1,129.21 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.29 / $895.96 / $1,045.28
| Professional | | $821.29 | $895.96 | $1,045.28 |
- 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
- $738.29 / $933.29 / $1,143.85
| Professional | | $738.29 | $933.29 | $1,143.85 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $825.84 / $3,619.79 / $9,324.00
| Professional | | $825.84 | $3,619.79 | $9,324.00 |