- 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 / $412.89 / $663.58
| Professional | | $412.89 | $412.89 | $663.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $349.26 / $843.88 / $6,910.27
| Professional | | $349.26 | $843.88 | $6,910.27 |
- 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
- $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
- $299.62 / $546.90 / $1,438.98
| Professional | | $299.62 | $546.90 | $1,438.98 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.38 / $257.02 / $387.06
| Professional | | $48.38 | $257.02 | $387.06 |