- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,890.45 / $7,244.36
| Facility | | $1,513.56 | $3,890.45 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $588.84 / $977.24
| Professional | | $251.19 | $588.84 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,096.48 / $1,096.48
| Facility | | $1,096.48 | $1,096.48 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $691.83 / $1,412.54
| Professional | | $316.23 | $691.83 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $676.08 / $1,174.90
| Professional | | $524.81 | $676.08 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $794.33 / $1,047.13
| Professional | | $251.19 | $794.33 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $660.69 / $1,000.00
| Professional | | $269.15 | $660.69 | $1,000.00 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $2,041.74 / $5,370.32
| Professional | | $346.74 | $2,041.74 | $5,370.32 |