- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $2,747.00 / $4,456.00
| Facility | | $1,324.03 | $2,747.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.00 / $415.00 / $552.92
| Professional | | $298.00 | $415.00 | $552.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,244.58 / $1,244.58 / $1,244.58
| Facility | | $1,244.58 | $1,244.58 | $1,244.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.62 / $582.86 / $1,237.21
| Professional | | $368.62 | $582.86 | $1,237.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.46 / $654.13 / $771.56
| Professional | | $561.46 | $654.13 | $771.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.22 / $582.86 / $742.86
| Professional | | $399.22 | $582.86 | $742.86 |
- 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
- $489.68 / $714.29 / $884.09
| Professional | | $489.68 | $714.29 | $884.09 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.26 / $2,500.00 / $6,063.00
| Professional | | $430.26 | $2,500.00 | $6,063.00 |