- 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
- $404.60 / $650.86 / $1,021.63
| Professional | | $404.60 | $650.86 | $1,021.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.99 / $786.61 / $943.94
| Professional | | $613.99 | $786.61 | $943.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.37 / $806.09 / $977.95
| Professional | | $685.37 | $806.09 | $977.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.03 / $679.13 / $786.61
| Professional | | $498.03 | $679.13 | $786.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $1,981.00 / $1,981.00
| Facility | | $1,981.00 | $1,981.00 | $1,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.88 / $791.46 / $1,025.81
| Professional | | $641.88 | $791.46 | $1,025.81 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.88 / $2,500.00 / $6,063.00
| Professional | | $531.88 | $2,500.00 | $6,063.00 |