- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $4,456.00
| Facility | | $1,758.00 | $2,747.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.93 / $487.67 / $2,137.00
| Professional | | $438.93 | $487.67 | $2,137.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.22 / $669.09 / $802.91
| Professional | | $513.22 | $669.09 | $802.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.10 / $771.97 / $5,851.00
| Professional | | $687.10 | $771.97 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.79 / $642.32 / $749.38
| Professional | | $588.79 | $642.32 | $749.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.48 / $669.09 / $830.61
| Professional | | $516.48 | $669.09 | $830.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.54 / $9,074.45 / $12,953.00
| Professional | | $611.54 | $9,074.45 | $12,953.00 |