- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,861.43 / $2,747.00 / $6,084.00
| Facility | | $1,861.43 | $2,747.00 | $6,084.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.25 / $510.61 / $614.33
| Professional | | $481.25 | $510.61 | $614.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.74 / $1,749.74 / $1,749.74
| Facility | | $1,749.74 | $1,749.74 | $1,749.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.54 / $741.29 / $1,370.05
| Professional | | $544.54 | $741.29 | $1,370.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $777.60 / $873.65 / $1,052.04
| Professional | | $777.60 | $873.65 | $1,052.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.33 / $711.64 / $830.24
| Professional | | $652.33 | $711.64 | $830.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $2,912.00 / $2,912.00
| Facility | | $2,912.00 | $2,912.00 | $2,912.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.69 / $741.29 / $964.86
| Professional | | $526.69 | $741.29 | $964.86 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.04 / $3,692.19 / $9,324.00
| Professional | | $539.04 | $3,692.19 | $9,324.00 |