- 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
- $417.07 / $461.75 / $682.84
| Professional | | $417.07 | $461.75 | $682.84 |
- 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
- $439.07 / $607.17 / $1,171.04
| Professional | | $439.07 | $607.17 | $1,171.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $641.11 / $720.31 / $867.39
| Professional | | $641.11 | $720.31 | $867.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.30 / $582.89 / $680.04
| Professional | | $534.30 | $582.89 | $680.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $1,981.00 / $1,981.00
| Facility | | $1,981.00 | $1,981.00 | $1,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $445.64 / $607.17 / $807.10
| Professional | | $445.64 | $607.17 | $807.10 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.96 / $2,575.00 / $6,124.00
| Professional | | $513.96 | $2,575.00 | $6,124.00 |