- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.43 / $2,747.00 / $6,084.00
| Facility | | $1,861.43 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.66 / $606.70 / $606.70
| Professional | | $536.66 | $606.70 | $606.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.33 / $683.98 / $705.41
| Professional | | $521.33 | $683.98 | $705.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.01 / $839.94 / $8,902.00
| Professional | | $730.01 | $839.94 | $8,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.90 / $656.62 / $766.05
| Professional | | $601.90 | $656.62 | $766.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $1,981.00 / $1,981.00
| Facility | | $1,981.00 | $1,981.00 | $1,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.12 / $683.98 / $870.24
| Professional | | $558.12 | $683.98 | $870.24 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.76 / $3,692.19 / $9,324.00
| Professional | | $537.76 | $3,692.19 | $9,324.00 |