- 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
- $373.93 / $528.08 / $654.04
| Professional | | $373.93 | $528.08 | $654.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $640.36 / $741.16 / $889.40
| Professional | | $640.36 | $741.16 | $889.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.95 / $868.43 / $6,501.00
| Professional | | $753.95 | $868.43 | $6,501.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.03 / $652.22 / $741.16
| Professional | | $532.03 | $652.22 | $741.16 |
- 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
- $530.58 / $710.69 / $939.38
| Professional | | $530.58 | $710.69 | $939.38 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.15 / $2,500.00 / $6,063.00
| Professional | | $534.15 | $2,500.00 | $6,063.00 |