- 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
- $571.97 / $810.40 / $1,290.90
| Professional | | $571.97 | $810.40 | $1,290.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.92 / $999.91 / $1,199.90
| Professional | | $863.92 | $999.91 | $1,199.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.75 / $1,173.28 / $6,946.00
| Professional | | $1,020.75 | $1,173.28 | $6,946.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.12 / $879.92 / $999.91
| Professional | | $731.12 | $879.92 | $999.91 |
- 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
- $725.41 / $965.75 / $1,273.49
| Professional | | $725.41 | $965.75 | $1,273.49 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.10 / $2,500.00 / $6,063.00
| Professional | | $722.10 | $2,500.00 | $6,063.00 |