- 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
- $465.09 / $492.80 / $604.29
| Professional | | $465.09 | $492.80 | $604.29 |
- 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
- $517.46 / $641.48 / $1,155.29
| Professional | | $517.46 | $641.48 | $1,155.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.98 / $757.24 / $870.83
| Professional | | $673.98 | $757.24 | $870.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.50 / $615.82 / $718.45
| Professional | | $564.50 | $615.82 | $718.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.00 / $1,689.00 / $1,689.00
| Facility | | $1,689.00 | $1,689.00 | $1,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.29 / $641.48 / $1,046.41
| Professional | | $471.29 | $641.48 | $1,046.41 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.73 / $2,582.96 / $6,124.00
| Professional | | $543.73 | $2,582.96 | $6,124.00 |