- 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
- $279.04 / $420.97 / $1,780.02
| Professional | | $279.04 | $420.97 | $1,780.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.16 / $1,638.34 / $1,724.11
| Professional | | $359.16 | $1,638.34 | $1,724.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.92 / $558.33 / $8,507.00
| Professional | | $450.92 | $558.33 | $8,507.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.88 / $1,517.22 / $1,724.11
| Professional | | $331.88 | $1,517.22 | $1,724.11 |
- 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
- $1,406.88 / $1,832.14 / $2,591.63
| Professional | | $1,406.88 | $1,832.14 | $2,591.63 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.70 / $3,239.97 / $5,401.00
| Professional | | $342.70 | $3,239.97 | $5,401.00 |