- 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
- $375.75 / $510.39 / $994.59
| Professional | | $375.75 | $510.39 | $994.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.86 / $764.89 / $917.87
| Professional | | $660.86 | $764.89 | $917.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.57 / $836.89 / $5,851.00
| Professional | | $726.57 | $836.89 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.03 / $673.10 / $764.89
| Professional | | $512.03 | $673.10 | $764.89 |
- 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
- $542.77 / $732.33 / $964.73
| Professional | | $542.77 | $732.33 | $964.73 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.19 / $2,500.00 / $6,063.00
| Professional | | $552.19 | $2,500.00 | $6,063.00 |