- 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
- $336.22 / $401.13 / $1,035.49
| Professional | | $336.22 | $401.13 | $1,035.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.50 / $1,041.08 / $1,169.67
| Professional | | $429.50 | $1,041.08 | $1,169.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.61 / $656.78 / $5,879.00
| Professional | | $526.61 | $656.78 | $5,879.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.32 / $916.16 / $1,041.08
| Professional | | $385.32 | $916.16 | $1,041.08 |
- 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
- $849.53 / $1,054.98 / $1,472.67
| Professional | | $849.53 | $1,054.98 | $1,472.67 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.37 / $2,500.00 / $6,063.00
| Professional | | $438.37 | $2,500.00 | $6,063.00 |