- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.00 / $6,084.00 / $7,424.00
| Facility | | $2,528.00 | $6,084.00 | $7,424.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.44 / $413.10 / $483.92
| Professional | | $371.44 | $413.10 | $483.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,267.63 / $3,267.63 / $3,267.63
| Facility | | $3,267.63 | $3,267.63 | $3,267.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.50 / $497.59 / $908.20
| Professional | | $421.50 | $497.59 | $908.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.21 / $653.01 / $750.96
| Professional | | $581.21 | $653.01 | $750.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.03 / $475.67 / $554.95
| Professional | | $436.03 | $475.67 | $554.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $383.27 / $498.26 / $725.65
| Professional | | $383.27 | $498.26 | $725.65 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.31 / $9,435.00 / $12,953.00
| Professional | | $436.31 | $9,435.00 | $12,953.00 |