- 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
- $387.37 / $570.89 / $1,136.57
| Professional | | $387.37 | $570.89 | $1,136.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.00 / $870.38 / $1,044.45
| Professional | | $752.00 | $870.38 | $1,044.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.75 / $907.28 / $5,092.00
| Professional | | $766.75 | $907.28 | $5,092.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.48 / $738.38 / $870.38
| Professional | | $541.48 | $738.38 | $870.38 |
- 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
- $618.35 / $781.51 / $872.13
| Professional | | $618.35 | $781.51 | $872.13 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.17 / $2,040.00 / $5,675.00
| Professional | | $546.17 | $2,040.00 | $5,675.00 |