- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $4,456.00 / $5,299.00
| Facility | | $1,758.00 | $4,456.00 | $5,299.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.44 / $543.74 / $783.39
| Professional | | $490.44 | $543.74 | $783.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.64 / $692.20 / $945.88
| Professional | | $608.64 | $692.20 | $945.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $800.46 / $1,036.20 / $6,873.30
| Professional | | $800.46 | $1,036.20 | $6,873.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.00 / $535.60 / $608.64
| Professional | | $372.00 | $535.60 | $608.64 |
- 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
- $496.65 / $620.58 / $839.15
| Professional | | $496.65 | $620.58 | $839.15 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.73 / $4,938.81 / $8,072.00
| Professional | | $397.73 | $4,938.81 | $8,072.00 |