- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $4,456.00 / $5,299.00
| Facility | | $1,758.00 | $4,456.00 | $5,299.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.89 / $491.17 / $708.83
| Professional | | $412.89 | $491.17 | $708.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.26 / $900.75 / $6,008.36
| Professional | | $349.26 | $900.75 | $6,008.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.35 / $386.57 / $451.00
| Professional | | $354.35 | $386.57 | $451.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $3,340.00 / $3,340.00
| Facility | | $3,340.00 | $3,340.00 | $3,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.06 / $597.69 / $2,116.02
| Professional | | $343.06 | $597.69 | $2,116.02 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.38 / $257.02 / $387.06
| Professional | | $48.38 | $257.02 | $387.06 |