- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $8,431.00 / $10,303.00
| Facility | | $2,747.00 | $8,431.00 | $10,303.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.36 / $525.07 / $2,589.73
| Professional | | $324.36 | $525.07 | $2,589.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.67 / $2,306.00 / $2,360.17
| Professional | | $417.67 | $2,306.00 | $2,360.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.59 / $601.94 / $3,063.67
| Professional | | $522.59 | $601.94 | $3,063.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.84 / $2,029.28 / $2,306.00
| Professional | | $383.84 | $2,029.28 | $2,306.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $3,028.00 / $3,028.00
| Facility | | $3,028.00 | $3,028.00 | $3,028.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,881.70 / $2,484.25 / $3,530.18
| Professional | | $1,881.70 | $2,484.25 | $3,530.18 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.13 / $442.46 / $2,789.42
| Professional | | $296.13 | $442.46 | $2,789.42 |