- 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
- $457.95 / $503.57 / $603.35
| Professional | | $457.95 | $503.57 | $603.35 |
- 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
- $525.13 / $630.69 / $1,147.44
| Professional | | $525.13 | $630.69 | $1,147.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.16 / $756.31 / $869.76
| Professional | | $673.16 | $756.31 | $869.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.22 / $608.96 / $710.46
| Professional | | $558.22 | $608.96 | $710.46 |
- 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
- $463.18 / $634.34 / $1,063.16
| Professional | | $463.18 | $634.34 | $1,063.16 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.96 / $2,582.96 / $6,124.00
| Professional | | $513.96 | $2,582.96 | $6,124.00 |