- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.55 / $2,747.00 / $5,484.00
| Facility | | $1,635.55 | $2,747.00 | $5,484.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.34 / $551.28 / $730.20
| Professional | | $505.34 | $551.28 | $730.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,537.42 / $1,537.42 / $1,537.42
| Facility | | $1,537.42 | $1,537.42 | $1,537.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.87 / $757.98 / $1,515.92
| Professional | | $548.87 | $757.98 | $1,515.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $805.88 / $905.43 / $1,090.30
| Professional | | $805.88 | $905.43 | $1,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.02 / $727.66 / $848.93
| Professional | | $667.02 | $727.66 | $848.93 |
- 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
- $554.28 / $757.98 / $1,090.52
| Professional | | $554.28 | $757.98 | $1,090.52 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.59 / $3,900.00 / $8,000.00
| Professional | | $738.59 | $3,900.00 | $8,000.00 |