- 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
- $417.92 / $551.75 / $652.04
| Professional | | $417.92 | $551.75 | $652.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.85 / $794.27 / $848.19
| Professional | | $605.85 | $794.27 | $848.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.66 / $960.12 / $1,206.52
| Professional | | $849.66 | $960.12 | $1,206.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $589.41 / $750.16 / $949.97
| Professional | | $589.41 | $750.16 | $949.97 |
- 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
- $779.47 / $842.81 / $1,081.01
| Professional | | $779.47 | $842.81 | $1,081.01 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.24 / $2,500.00 / $6,063.00
| Professional | | $609.24 | $2,500.00 | $6,063.00 |