- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $3,333.70 / $4,456.00
| Facility | | $1,758.00 | $3,333.70 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.52 / $337.40 / $1,259.75
| Professional | | $299.52 | $337.40 | $1,259.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.23 / $464.20 / $557.04
| Professional | | $355.23 | $464.20 | $557.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.00 / $541.54 / $3,857.00
| Professional | | $482.00 | $541.54 | $3,857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.50 / $445.63 / $519.90
| Professional | | $408.50 | $445.63 | $519.90 |
- 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
- $378.79 / $464.20 / $559.62
| Professional | | $378.79 | $464.20 | $559.62 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.67 / $2,582.96 / $6,124.00
| Professional | | $455.67 | $2,582.96 | $6,124.00 |