- 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
- $541.02 / $582.02 / $2,383.94
| Professional | | $541.02 | $582.02 | $2,383.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.97 / $712.06 / $712.06
| Professional | | $565.97 | $712.06 | $712.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $826.37 / $950.81 / $6,874.20
| Professional | | $826.37 | $950.81 | $6,874.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.62 / $683.58 / $797.51
| Professional | | $626.62 | $683.58 | $797.51 |
- 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
- $581.04 / $712.06 / $915.27
| Professional | | $581.04 | $712.06 | $915.27 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.96 / $2,582.96 / $6,124.00
| Professional | | $513.96 | $2,582.96 | $6,124.00 |