- 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
- $207.51 / $305.23 / $418.57
| Professional | | $207.51 | $305.23 | $418.57 |
- 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
- $250.02 / $403.11 / $994.17
| Professional | | $250.02 | $403.11 | $994.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.92 / $435.32 / $576.29
| Professional | | $365.92 | $435.32 | $576.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.66 / $423.54 / $581.34
| Professional | | $266.66 | $423.54 | $581.34 |
- 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
- $328.78 / $512.41 / $656.35
| Professional | | $328.78 | $512.41 | $656.35 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.77 / $2,500.00 / $6,063.00
| Professional | | $311.77 | $2,500.00 | $6,063.00 |